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Sunday, 06 December 2015 22:50

Health systems turn to telemedicine to offer more efficient care

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Bronson Children’s Hospital recently partnered with Spectrum Health on a telemedicine project that Medical Director Dr. Aaron Lane-Davies hopes will lay the groundwork for the Kalamazoo-based organization to expand the services more broadly in the next one or two years. The present partnerships are a “starting point so we can get better very quickly in this area,” Lane-Davies said. Bronson Children’s Hospital recently partnered with Spectrum Health on a telemedicine project that Medical Director Dr. Aaron Lane-Davies hopes will lay the groundwork for the Kalamazoo-based organization to expand the services more broadly in the next one or two years. The present partnerships are a “starting point so we can get better very quickly in this area,” Lane-Davies said. COURTESY PHOTO

GRAND RAPIDS — Hospital systems across West Michigan increasingly have turned to telemedicine to provide broader access to health care and better connect doctors to patients.

Under Spectrum Health’s MedNow virtual health service, a patient can connect with a Spectrum Health doctor for an online video visit for minor or low-acuity medical conditions such as a cold, the flu or a rash.

The telemedicine service by Spectrum Health — as well as initiatives at other health systems in the region, including Mercy Health, Borgess Health and Bronson Healthcare Group — represents an ongoing evolution in medicine in the digital age.

Consumers are beginning to demand greater access to care providers that’s more convenient to them and on their terms. Enabled by today’s technology and connectivity and aided by the advancement of electronic medical records in the last decade, health systems and physicians are responding accordingly and changing the way they offer care, said Tracey Burke, director of MedNow.

“Historically, we’ve always told people they need to come to us (and) they need to wait for us. Now we’re totally shifting our mindset to be more patient-centric to meet the needs of when they need us and how they want to connect with us. It’s a huge shift,” Burke said. “Now we’re switching that to be really, truly patient-focused and on meeting their needs, not having them meet ours.”

Spectrum Health launched MedNow in September. Available through an app, MedNow builds on and largely replaces a telemedicine service that Spectrum-owned health plan Priority Health launched in mid-2014 using Florida-based MDLIVE. That service electronically connects people with a doctor during off-hours.

The health system opted to retool and launch the in-house MedNow service because MDLIVE was not a comprehensive offering and physicians did not have access to patients’ electronic medical records, Burke said.

MedNow offers virtual visits in three areas: low-acuity primary-care visits for adults, follow-up virtual visits with medical specialists, and at-home monitoring for patients with chronic medical conditions.


In the case of primary-care visits, which are open to non-Spectrum Health patients as well, the goal is to offer greater and lower-cost access to care that is more convenient for consumers and keeps people from a higher-cost setting such as an emergency room or urgent care center. Patients who opt to use the service are first triaged to check if their conditions are appropriate for virtual visits. If so, they then are scheduled for an online video consultation with a doctor through their laptop, tablet or smartphone.

If their conditions exceed the parameters of a virtual visit and need more attention, the patients are referred to the needed care setting — even the emergency room, if necessary, Burke said.

The virtual visit costs $45, an amount fully covered by Priority Health. No other health insurers cover the visit right now, although Spectrum Health is working to sign reimbursement agreements for virtual visits with other health insurers.

While the move into telemedicine has its pitfalls — namely maintaining quality and continuity of care, as well as assuring that it’s used for the right patients and under the right circumstances — doctors and hospitals need to evolve and adapt, said Dr. Doug Apple, chief medical officer at the Spectrum Health Medical Group. The cost of care today remains simply unsustainable and telemedicine offers a less-expensive model to deliver care, Apple said.

“Not connecting leaves us in a state that we just can’t afford going forward, and that’s just not good for customers,” he said. “There are a lot of people who think this is about making more money. The reality is there is not much more money to be made in health care. We’re trying to provide ways in which we reduce costs but still improve quality. This, to me, is one of those solutions.”

Seeking to further build its telemedicine effort, Spectrum Health last month received a $254,844 grant from the U.S. Department of Agriculture to expand its specialty services into rural areas. The program targets offerings including oncology, diabetes education, infectious disease and pediatrics. 


As Spectrum Health, the largest health system in the region, moves deeper into telemedicine, other organizations are taking similar steps.

Bronson Children’s Hospital in Kalamazoo recently started its foray into telemedicine to improve access to highly specialized care for pediatric patients, to fill gaps where certain specialties are unavailable locally, and to extend its expertise to others. The hospital recently received a grant to purchase a telemedicine cart to provide subspecialty care in the newborn unit at Bronson Battle Creek Hospital.

The organization launched a partnership several weeks ago with Spectrum Health for consultations with pediatric nephrologists and neurologists for hospitalized inpatients. Telemedicine carts using high-definition monitors and equipment allow the specialist to look into the ears, eyes and mouth of their young patients. They can also deploy a remote stethoscope to listen to patients’ hearts.

Bronson is developing a separate partnership with another children’s hospital for outpatient telemedicine visits by medical subspecialists that remain unavailable in Kalamazoo, avoiding the need for patients and their families to travel a long distance for care.

The partnerships lay the groundwork and provide the learning for Bronson to deploy telemedicine more broadly in the next year or two, said Dr. Aaron Lane-Davies, medical director at Bronson Children’s Hospital. The services should improve patient access to specialists and subspecialists, better provide primary and in-home care, and monitor and manage patients with chronic medical conditions, he said.

The present partnerships are a “starting point so we can get better very quickly in this area,” Lane-Davies said.

“We are really using them to sort of get our skills and technology infrastructure up to speed so we can really leverage it in a way that people expect,” he said. “There is, in my opinion, a role for telemedicine all the way across the medical continuum.

“We’re trying to bring that to speed as quickly as we can.”


In Dowagiac, the Borgess Lee Medical Group partnered last month with DeLano Outpatient Clinic in Kalamazoo, a part of Borgess Behavioral Health, for telemedicine behavioral health services for adult and pediatric patients a half day each week.

Mercy Health in Grand Rapids last spring launched a pilot program using the telemedicine platform for doctor-to-doctor neurology consultations, as well as to connect patients with chronic headaches to a neurologist. The service expedites scheduling patient visits and eliminates travel time if they live in a rural area. The neurologist, based on his or her findings in the virtual visit, then decides if the patient needs an in-office exam or referral to a subspecialist.

From the pilot, which ran from early May to the end of June and involved an average of 10 patients a week, Mercy Health concluded “there’s great value to this” and “this is a foothold potentially across the board in other specialty areas,” said Mercy Health Medical Director Dr. Fred Reyelts. That’s especially true for medical fields where there is a long wait time for an office appointment or a shortage of physicians, he said.

“We need to figure out how do we get this applied within our system to more physicians” both for specialists and in primary care visits and to monitor and manage chronically ill patients, Reyelts said.


As telemedicine emerges, reimbursement payments to doctors and hospitals that largely remained tied to face-to-face visits are “perhaps the biggest impediment” to telemedicine, although that’s beginning to change, Reyelts said. He’s hopeful reimbursement practices will change as telemedicine services increasingly are deployed and used.

“Let’s pay to do the right thing for the patient, not necessarily to see them,” Reyelts said. “If we are no longer held to this reimbursement, we can create models that really are better for everyone. They utilize, for the most part, relatively scarce resources and use them more effectively and efficiently.”

Many health systems now work with health insurers through value-based contracts that are based on outcomes and quality rather than volume of services. That shift opens the door for reimbursements for telemedicine services, too.

The job for care providers is to prove telemedicine’s merits to health insurers, according to industry sources.

“It’s incumbent on us who are doing this effort to help the insurance (provider) understand how this provides value and that it does indeed provide value,” said Lane-Davies of Bronson Children’s Hospital. “There will be a convergence of both of those things, where the technology and the reimbursement will come together. That will happen fairly quickly as people and organizations like Bronson and Spectrum demonstrate the value this has for patients and families.”


Blue Cross Blue Shield of Michigan, the largest health insurer in the state, plans to launch its own 24-hour telemedicine initiative starting Jan. 1, 2016 and currently is examining its reimbursement policy.

Working with Boston-based telemedicine provider American Well, Blue Cross Blue Shield will start by offering online access to physicians for primary-care virtual visits when a member’s own doctor is unavailable, such as late at night. The insurer will expand the service throughout the year, said Jason Machasic, Blue Cross Blue Shield’s corporate marketing director.

“We are very aware of the consumer need for just the convenience and the access to additional care whenever and wherever people need it,” Machasic said.

Part of the push for telemedicine comes from employers that are increasingly incorporating services into their benefits packages for employees.

In the 2015 survey of large employers by the National Business Group on Health, 74 percent of respondents said they intended to offer a telemedicine benefit in 2016, versus 48 percent this year.

An annual survey by benefits consultant Mercer found telemedicine is now offered by 44 percent of “jumbo” employers, or those with 20,000 or more employees, which compares to 34 percent last year. Telemedicine is now a benefit at 30 percent of large employers that responded to the Mercer survey that had 500 or more employees, compared to 18 percent last year.

Mick Young, business leader at Mercer’s Grand Rapids office, expects the growth in telemedicine to continue at a high rate as employers look to impact medical claims trends that drive the rates they pay for employee health coverage.

“There’s going to be a ton of movement in that area,” Young said. “It’s become a generally accepted way of managing health.”


EDITOR'S NOTE: This story has been modified to correctly identify the job title of Tacey Burke

Read 7012 times Last modified on Wednesday, 16 December 2015 00:04

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