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Summary - Telehealth to Support Primary Care

​The emergence of COVID-19 has required an unprecedented and precipitous shift in how health care is delivered in the United States. Social distancing, fear of infection, and health care providers sidelined by mandatory quarantine present challenges to traditional clinical care at a time when the need for services is rapidly escalating. Recognizing these challenges, federal and state governments have recently issued waivers to support telehealth utilization, removing limitations and restrictions on service coverage, location, and modality.   

Technology and telehealth may be particularly well-suited for use in primary care, where the need for services like chronic disease management and preventative medicine remain, but risk of infection or access issues related to COVID-19 have made office visits a diminishing option. As part of the webinar series Emergency Health Workforce Policies to Address COVID-19, the Fitzhugh Mullan Institute for Health Workforce Equity presents a webinar on how telehealth is being used to support primary care practice in the wake of COVID-19. Moderated by Dr. Guenevere Burke with the Mullan Institute, the webinar features Dr. Sanjeev Arora, Founder and Director of Project ECHO and Dr. Robert Phillips with the American Board of Family Medicine as panelists.
​
Founded in 2003, Project ECHO (ECHO) harnesses a hub and spoke model and innovative technology platform to build specialty care capacity in primary care settings. Dr. Arora explains how ECHO is leveraging its telementoring model to respond to provider training and education needs presented by the current pandemic, with  sessions intended to amplify public health and clinical care preparedness and response (timestamp 08:50). Demand for the trainings has been unprecedented for ECHO: “In all of the history of ECHO we have trained about ninety-seven thousand mentees, but in the last two weeks, we have trained more than one hundred thousand additional physicians and nurses across the world…on COVID-19 best practices”, says Dr. Arora.  Project ECHO Covid-19 best practices include:
  • How to adapt and enforce rigorous infection control practices?
  • How to cope with PPE shortages?
  • How to rapidly deploy telehealth services? 
  • How to prioritize limited testing resources? 
  • How to isolate homeless and unsheltered individuals with symptoms?
  • How to create a COVID-19 floor?
  • When to send someone to the ICU?
Dr. Robert Phillips provides a primary practice perspective, noting that the recent telehealth waivers to Medicare and Medicaid have resulted in rapid progress in advancing telehealth that practitioners and patients may not want to see halted after waivers expire. “After years of trying to get expansion of telehealth both for protections under HIPPA and for payment, it’s [going to] be hard to put this genie back in the bottle”, says Phillips. He goes on to describe the impact COVID-19 has had on primary care practice, particularly in FQHCs, which are seeing 50-70% reductions in office visits (timestamp 20:25). Phillips warns that the consequences of reduced service delivery, and the decrease in revenue that accompanies it, could spell disaster for primary care practices’ ability to remain in business just as the pandemic is ramping up.

While telehealth offers a potential solution to maintaining some level of health care delivery during the pandemic, Phillips notes that challenges to implementation remain (timestamp 22:30). For one, there is a lack of uniformity across federal, state, and private payer policies on telehealth, causing confusion among providers and billers. Patient access to and comprehension of telehealth platforms may further stifle its utility, and overhead costs related to telehealth can be too high for some providers to absorb. Phillips is hopeful that telehealth support included in the recently signed stimulus bill will offset some of these cost barriers.  

The webinar concludes with Drs. Arora and Phillips take on innovation’s role in supporting vulnerable populations. Dr. Arora reiterates Project ECHO’s mission of democratizing best practices in clinical care and implementing them for underserved populations (timestamp 26:50). He notes that Medicaid patients and the uninsured have a particularly difficult time accessing specialty care, including infectious disease specialists. Many of these patients rely on FQHCs or other community clinics for all their health care needs, highlighting the need to scale up specialty care knowledge in these settings and the opportunity Project ECHO provides to do so. Dr. Phillips describes current efforts to enhance COVID-19 data tracking in rural and isolated communities where the pandemic’s tail is likely to be longer than in more heavily resourced urban settings. “We believe that if we can help CDC by sharing data with them about what’s happening in rural and underserved areas, that it may help focus their attention and resources on these areas, too”(timestamp 29:40).
​
Dr. Burke concludes the webinar with a quote from Mullan Institute founder, Dr. Fitzhugh Mullan, “Health workforce policy is increasingly a health equity battleground”. Other webinars in this series will explore actions that can be taken to support all members of our healthcare workforce as they serve on the front lines of the COVID-19 pandemic.  ​

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  • About
    • Core Faculty and Staff
    • Affiliated Faculty
    • International Collaborators
    • Advisory Board
    • Legacy Fund
    • In Memoriam >
      • Catarina Castruccio-Prince
      • Fitzhugh Mullan
    • Contact Us
  • Workforce Trackers
  • Research
    • Behavioral Health Workforce
    • Diversity Initiative
    • Medicaid Primary Care Workforce
    • Moral Injury
    • Reproductive Health Workforce & Policy Research Center
    • Home Care Workforce
    • Social Mission Metrics
    • Health Workforce Research Centers
    • COVID-19 Webinars
  • Action
    • Social Mission Alliance
    • Workplace Change Collaborative
    • Health Workforce Equity Summit
    • Health Workforce Speakers
    • Where are we speaking?
  • Education
    • Atlantic Fellows for Health Equity
    • Health Leadership Impact Fellowship
    • ​Residency Fellowship in Health Policy
  • Publications
    • Reports & White Papers