The Minnesota Department of Human Services report (Telemedicine Utilization Report: Telehealth and Telemedicine during the COVID-19 Pandemic) looks at increased use of and decreased regulation on telehealth during the pandemic. Their high level assessment…

Recommendations for further consideration by DHS include:

• integrating telemedicine as a permanent modality in delivery of services, developing specific guidance on licensing standards around telemedicine;
• investing resources in understanding comparatively low level of utilization of telemedicine by Black, Indigenous, and People of Color (BIPOC) communities;
• advocating and prioritizing funding for telehealth infrastructure development; and
• supporting legislation to allow Medical Assistance (MA) and MinnesotaCare enrollees to have more than three telemedicine visits in a week.

The report is direct, easy to read and includes information that supports the recommendations. I’m going to try to pull out the salient points by segment, which means I’m removing some context to provide a quicker look at the data but again, you can go to the full report for more detail.

From the Contextual analysis: a brief review of contemporary literature

• Telehealth and telemedicine have shown to increase access to patients, communities, and vulnerable populations, including adolescents, adults, seniors, veterans, rural patients, persons diagnosed with a disability and/or a mental health condition, and persons with transportation barriers and mobility issues.
• The provision of health care services via telehealth and telemedicine has been shown to decrease the wait times for emergency departments, an appointment with a general practitioner, and referrals to several medical specialties, such as behavioral health and Ear, Nose and Throat (ENT).
• Telehealth and telemedicine can be utilized to provide prevention and early intervention services and to support follow-up care for chronic conditions.

From the Initial stakeholder feedback summary

• Telehealth made it easier to access services, and easier to involve other family members in healthcare services.
• Telehealth freed-up time to serve more clients/patients in need of services since healthcare staff could provide services from one location, eliminating drive-time between provider sites.
• Patient/client attendance was improved by fewer “no-shows” and late arrivals.
• Some patients who would otherwise not access care due to their illness, travel distance, lack of transportation, lack of child/senior care, or level of motivation, can more easily access services in the comfort of their home.
• The input from metro county ethnic minority groups and rural tribal recipients were positive for telehealth service provision, noting that telehealth improves equity in access to healthcare.
• Responses from ethnic minority groups and rural tribal recipient groups mentioned a preference that telehealth be provided by telephone and not via the internet.

From the Claims data analysis

• Of the individuals who utilized telemedicine for all health care services, 20% used telemedicine-only, 15% started services after the PHE and have continued follow-up via telemedicine, approximately 50% of individuals stopped services (submitted no claims after the PHE).
• Results indicate that of the 87.3% of individuals who received health care services, approximately 25% of the recipients engaged in telemedicine care. Moreover, 14.3% of patients receiving Medicaid who needed care and did not utilize in-person visits were able to utilize telemedicine-only services after the PHE. Further investigation on these particular utilization groups is warranted and could illuminate how to better engage individuals with telemedicine health care services.
• Results suggest changes in telemedicine utilization which impact age groups differently. Specifically, individuals within age groups 0-5 years old and 66+ years old had more telemedicine claims compared to individuals 6-65 years old. This is inconsistent with the CMS Medicaid and CHIP snapshot data, which found that working age adults were more likely to utilize telemedicine services.
• To measure provider and service patterns at a more gradient level, next steps will utilize longitudinal method with monthly and/or weekly time points starting in January 2020 to more accurately identify telemedicine trends in provider and services.
• Age and additional demographics warrant further investigation based on volume based on services received.
• Further examination on service patterns based on services being utilized by individual differences including racial and ethnic groups and geographic location.

From Focus groups (Provider recommendations)

• Clear guidelines from DHS on billing and payment, patient notes and any other aspects of care or charting which may be audited or should be standardized across practitioners.
• State assistance (grants, legislation, etc.) to ensure access to high speed Internet statewide, both for providers and facilities and for patients, especially in rural areas.
• Providers particularly want to ensure that telephone continues to be viewed as a viable form of treatment and billable on par with video treatment options.
  • This is especially important as Internet availability and reliability continue to be a barrier for many patients in accessing remote medicine via video services.
• Move to a single or greatly reduced number of HIPAA compliant, easy to use, affordable platforms as the vast number of different programs used currently can create difficulties in coordination of care among facilities, providers and other agencies as well as difficulties for patients who see multiple providers utilizing different systems.
• One idea is to create a public- private partnership between DHS and a telemedicine platform company which would allow for a low-cost, HIPAA compliant system used by most Minnesota providers. o Pursue interstate licensure for telemedicine so providers close to state borders can serve more patients.
  • Promote collaboration with insurance companies and the state insurance commissioner to ensure equity in billing of telemedicine for patients across Minnesota-based insurance companies.
• Interpreters are an important part of providing mental health and substance use care, and these providers urged that they be included in supporting a successful telemedicine model in Minnesota.
  • These providers stressed that interpreters who are providing ancillary support to providers should be included in any grant funding for devices, Internet provision or other technological assistance as they are currently left to cover these costs themselves.
  • Likewise, if there is to be any standardization of care guidelines or regulations created by DHS, they should take into account the need for interpreters and having a three-way video call, phone call or other means of utilizing interpreter services.

Lessons learned

• Integrate telemedicine as a permanent modality in delivery of services
• Provide training, assistance and clarification in provider manual regarding use of telemedicine
• Offer specific guidance for Office of Inspector General on review of licensing standards around telemedicine
• Invest resources in exploring reasons behind comparatively low level of utilization of telemedicine by Black, Indigenous, and People of Color (BIPOC) communities
• Use of telephone-only as a telemedicine modality for clinical services needs to be examined further and independently of other telemedicine modalities. o Possibly keep this as an option for future public health emergencies.