Patients in West Michigan are more apt than people in the southeastern part of the state to connect with a doctor virtually to manage two chronic illnesses.
That’s one finding in Grand Valley State University’s 2019 Health Check report, which shows a far higher utilization rate in the region for telehealth as an ongoing treatment option for diabetes and coronary artery disease.
While the use remains low overall, the finding did affirm how telehealth has been emerging as a means to connect patients and their physicians at a lower cost.
“It’s going to be really interesting to see how this develops over time and what this usage looks like over time,” said Kevin Callison, assistant professor of public health and tropical medicine at Tulane University and co-author of the 2019 Health Check report.
While he cannot specifically explain the variations in telehealth utilization rates between each side of the state, Callison speculates they could stem from West Michigan’s more rural nature. Claims data from Priority Heath and Blue Cross Blue Shield of Michigan show the highest telehealth utilization rates to manage diabetes and heart disease were in the rural ZIP codes of West Michigan, he said.
Although the report’s authors do not offer specifics, data maps in the Health Check report show several ZIP codes in Kent, Ottawa, Muskegon and Allegan counties where Blue Cross and Priority Health members with diabetes tend to use telehealth visits to manage their condition more than similar patients in the Detroit area. In the ZIP codes with the highest use rates, diabetes patients’ use of telehealth still averaged just 0.021 to 0.078 visits annually across the entire book of business in the market for Blue Cross and Priority Health in West Michigan.
Callison noted that this year was the first time GVSU tracked telehealth visits, which offer patients a more convenient way to consult with physicians when they are sick or managing a chronic medical condition such as diabetes or heart disease.
“We’re already starting to see some interesting things here, but it’ll be particularly helpful to see how this grows over time,” Callison said.
Most care providers now have a telehealth platform to serve patients virtually — whether online or through an app on their smartphones or tablets — for primary care doctor visits and other uses such as managing chronic medical conditions.
Spectrum Health launched its MedNow telehealth service in mid 2014 and has seen strong year-over-year growth ever since, President and CEO Tina Freese Decker said in a panel discussion following the presentation of the latest Health Check report. In just January of last year, MedNow’s use grew some 300 percent as Spectrum Health targeted people with the flu to use a virtual doctor visit instead of going to the ER, Freese Decker said.
Freese Decker expects the use of telehealth to continue to grow for low-acuity patient services, such as for primary care and medical specialties. She thinks the technology eventually will become commonplace in the industry.
“We’ll be doing more things in how do we connect with more people in their home (and) using their home devices,” she said. “Eventually, telemedicine will be just like anything else. We won’t call it ‘digital health.’ It’ll just be ‘health,’ but today we call it that because we have to think differently and we have to make sure we’re thinking digitally first, instead of thinking in a physical format right now.”
Since launching, MedNow has recorded 72,000 virtual visits between patients and Spectrum Health doctors, Senior Director Joe Brennan said. About 44,000 of those encounters were primary care virtual visits. The rest were between patients in a physician’s office and specialists based elsewhere.
Nearly 35,000 of the overall total virtual visits since mid 2014 happened in 2018 alone, as telehealth gained further traction with consumers, Brennan said. He describes telehealth as a “nascent” industry.
“We’re now starting to hit the point where most people in health care understand this is the way things are moving,” he said.
Spectrum Health estimates that MedNow, which charges $45 per primary care virtual visit, has avoided $6.1 million in costs to insurers since launching, prevented more than 17,000 visits to higher-cost ERs or urgent care centers, and saved patients 1.3 million miles of travel.
Telehealth offers health care providers a venue to use beyond patients’ virtual visits with doctors. Hospitals and medical practices can use the platforms for consultation between doctors on patient cases, or to bring specialty care into low-volume rural markets.
“We’re able to bring that expertise out into the field with telehealth,” said Rob Casalou, regional president and CEO for Trinity Health in Michigan, the parent organization that includes Mercy Health operations in West Michigan.
Telehealth started slowly because “it wasn’t getting paid” for by insurers “so it wasn’t getting done,” Casalou said. As care providers increasingly are paid based on “episodes of care” to treat an illness rather than for individual visits, they’ve turned more to telehealth as a way to connect with patients, he said.
“Now, suddenly, the virtual visits, at least in our networks, are growing exponentially because it’s a way to manage care outside of the office (and) outside of the hospital,” Casalou said.
Mercy Health’s telehealth platform launched in October 2017 and has recorded more than 10,000 interactions, or about 600 per month. Mercy Health Virtual Visits uses a telehealth platform provided by Minneapolis, Minn.-based Zipnosis Inc.
Data from Zipnosis indicate that 40 percent of patients using virtual visits would otherwise have gone to an urgent care center and 31 percent would have seen their primary care physicians. Sixteen percent would have gone to a local retail medical clinic and 7 percent would not even have sought care for their conditions, according to Zipnosis.
Dr. Rakesh Pai, medical group president and chief population health officer at Metro Health-University of Michigan Health System, describes telehealth as a “pervasive trend” that’s changing how health care gets delivered.
Telehealth will become “the way care will just be delivered and we won’t make that distinction” between in-person visits and virtual visits, Pai said during the GVSU panel discussion, during which he acknowledged Metro Health was “admittedly a little bit behind” on the trend.
Telehealth also provides an important way for care teams at different locations to connect when deciding where best to treat a patient and for determining transfers from one facility to another, Pai said.