Tag Archives: coronavirus

Study shows Minnesotans happy with telehealth – but barrier exist – such as no broadband

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The Minnesota Department of Health reports…

A new study produced by the Minnesota Department of Health (MDH) highlights the potential for telehealth to make care more accessible while providing similar levels of service to traditional, in-person ways of delivering care. Telehealth is the use of electronic or telecommunications technology to access health care remotely. …

The preliminary report’s findings, which focus on Minnesotans with private health insurance coverage, show that the use of telehealth increased significantly during the COVID-19 pandemic. Data also showed that most patients receiving telehealth services were satisfied with their experience. Overall, about 80% of Minnesotans surveyed by MDH during the study period were satisfied with the telehealth services they received, regardless of whether it was a video or audio visit. In addition, the study found telehealth has the potential to increase access to health care by removing barriers like transportation and the need to arrange child care.

There’s a special nod to increased mental health access…

Telehealth’s impact has been particularly strong in expanding access to mental and behavioral health providers. During the first half of 2021, about 60% of all mental and behavioral health services were delivered through telehealth. This finding is especially important for improving access to care for residents of Greater Minnesota, where telehealth has the potential to fill provider coverage gaps that make attaining care especially challenging.

But access to telehealth is not equitable…

The report does note several equity issues to consider with telehealth. For instance, some providers reported challenges in ensuring adequate support for patients whose first language is not English. In addition, while patient satisfaction with telehealth was positive overall, it was somewhat lower for Black, Indigenous and people of color (BIPOC) Minnesotans. Communities that face disproportionate inequities in digital access and affordability, or comfort in using digital technology, face barriers to telehealth access. Still, telehealth provides opportunities to address disparities compared to in-person care, particularly the potential for connecting culturally or linguistically “matched” provider and client pairs without the barrier of physical distance.

Telehealth not as prevalent in rural MN – due to broadband issues

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The Post Bulletin reports…

Between 2019 and 2022, MDH found that telehealth use among most categories of health care providers grew. Among Minnesota’s physicians, for example, 64% report using telehealth at least some of the time in 2022, compared to 32% in 2019. Mental health providers saw the biggest jump in telehealth use, with 80% of those providers using telehealth some of the time versus 21% in 2019.

But that uptick isn’t evenly distributed between rural and urban patients. Per MDH’s 2021 Minnesota Health Access Survey, rural Minnesotans were less likely to use video or telephone visits than urban residents.

“It’s really hard to characterize the penetration of telehealth, but by almost every measure … people in urban areas used more telehealth during the pandemic and continue to this day to use more telehealth than folks who live in rural areas,” said Jonathan Neufeld, director of the Great Plains Telehealth Resource and Assistance Center, based at the University of Minnesota.

Why?

The answer, according to Neufeld, is nuanced. A mix of post-pandemic preferences, internet access and provider availability all come into play when a patient decides whether or not to see their doctor from their living room — or if that option is available at all.

Broadband is a big issue…

MDH’s Minnesota Health Access Survey found that almost 20% of rural Minnesotans don’t have access to internet reliable enough for a video visit. This lack of internet access is an acute issue for rural medical providers. At Gundersen St. Elizabeth’s Hospital in Wabasha, clinical social worker Mindy Wise sees it firsthand.

“It’d be great if everybody had internet access at fair and reasonable costs, especially for the senior group,” Wise said. “The budget can be a difficult thing for some people.”

Providers ran into similar problems at Zumbro Valley Health Center. Heather Geerts, ZVHC director of clinical services, said even if patients have a cell phone, limited data can make a telehealth visit less desirable.

New COVID-19 telehealth test-to-treat program in MN

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KARE 11 reports…

The Minnesota Department of Health (MDH) announced a new COVID-19 telehealth test-to-treat program Monday that ensures anyone who tests positive for the virus will have access to clinician care and therapeutic treatments to reduce the risk of serious illness or hospitalization.

All of the services provided through the pilot program including the consultation, medication and delivery, will come at no cost.

According to a press release from MDH, the state’s pilot program works with both at-home and lab COVID-19 tests regardless of brand.

The department says Minnesotans who test positive for COVID-19 can download the Cue Health app to schedule a virtual consultation with a licensed clinician who will determine if therapeutic treatment is a good option.

If the clinician determines that if the infected person is a good candidate for therapeutics, the clinician can issue that prescription to the patient’s local pharmacy.

Who telecommuted during COVID and what does that tell us about future use in Minnesota?

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The West Central Tribune reports…

A new study from University of Minnesota Extension and the Minnesota Department of Transportation offers the most comprehensive look to date at how telecommuting in Minnesota has changed since the COVID-19 pandemic began.

In 2020, Minnesota saw a pivotal shift in the number of people working from home due to the pandemic. MnDOT wanted to capture Minnesota-specific data to understand who is working from home, how it is going, and what the future might look like.

Findings:

  • While the image of an average telecommuter tends to skew young, Extension researchers found that Baby Boomers — the oldest among workers — telecommuted the most. The researchers surveyed more than 1,200 Minnesota employees and employers, in addition to conducting focus groups.
  • Looking forward, the state can expect the greatest levels of telecommuting from people with longer commutes, two-year college degrees and metro-area homes. The data serves as a snapshot in time; it has evolved since 2021 and will continue to change.
  • Whereas three-quarters of employees reported that their organizations will allow teleworking at least part-time post-COVID, not all employers are on board. Nearly a quarter of surveyed employers oppose all but the most minimal telecommuting going forward, even if work allows for it.
  • Greater Minnesota respondents were more likely to telecommute no more than one day a week post-pandemic, while Twin Cities respondents were more likely to telecommute two to three days a week. However, there was no difference between Greater Minnesota and the metro area if respondents were likely to commute four to five days a week.
  • People with children at home are more likely to have formal post-pandemic telecommuting agreements with their employers.
  • Roughly a quarter of employers may recruit completely remote talent from outside of Minnesota.

Hospital at Home Programs gaining popularity

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Minnesota Monthly reports…

Rachel Riedesel, population health manager at Allina Health, was in her final year of the Masters of Healthcare Administration program at the University of Minnesota School of Public Health in 2019. For her team capstone project, she partnered with leaders at Allina Health to design a program that would allow patients to receive hospital care in the comfort of their homes.

At the time, funding models and abundant hospital capacity meant there was little urgency to implement the program. All that changed when the pandemic hit. By then, Riedesel was working at Allina Health in the hub of the system’s COVID-19-related activity. “This came forward as an opportunity to increase hospital capacity while we were trying to serve our community and their needs,” Riedesel says. The Hospital at Home plan she had previously worked on was put in motion. “We were able to deploy the program in less than a month because of the plans we’d already prepared.”

Instead of being checked into the hospital, patients who participate in the program are sent home with biometric monitoring equipment. The kit includes a tablet, blood pressure cuff, pulse oximeter, and thermometer—all Bluetooth-enabled. Patients are continuously monitored, and their data is sent to a centralized nursing hub along with personalized parameters. If their biometric markers go outside of a preset zone, nurses are alerted to check on them. If needed, a nurse, physician, or paramedic may also be dispatched to the patient’s home. “We have an escalation process in place to ensure the patient is safe,” Riedesel says.

Allina’s program is now one of the fastest growing Hospital at Home programs in the country. To date, it has served roughly 3,700 patients in the Twin Cities metro and a few regional areas throughout the state. When the program started, 60% to 70% of the Hospital at Home patients were COVID-19-positive. In 2022, it’s closer to 40%. The bulk of the patients are now being treated primarily for other conditions, such as sepsis, chronic heart failure, chronic obstructive pulmonary disease (COPD), and post-surgery recovery.

“We continue to see equal- or better-quality outcomes for people who get to recover in their homes, with their loved ones,” Riedesel says. While in-patient hospital care is necessary for some acute conditions, hospitals are not without risk. The Centers for Disease Control and Prevention (CDC) estimates hospital-acquired infections account for 1.7 million infections and 99,000 deaths each year. “We want to make sure we’re providing the safest care in the safest place, and that can often be the patient’s home,” Riedesel says.

Telehealth visits a boon to vets with opioid addiction

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It’s hard to compare the last two years with anything before, given the impact of COVID but even given that difference (or maybe because of it) the stats on veterans in recovery and their use of technology. Southern Minn reports…

There are many obstacles to opioid addiction treatment, but a new study shows one that one outgrowth of the COVID pandemic — telehealth — is enabling more U.S. veterans to get help.

Researchers examined care given to vets before and after a transition to telehealth visits in early 2020 for treatment of their opioid use disorder. Telehealth for patients receiving the prescription drug buphrenorphine to treat opioid dependence was relatively new in the Veterans Affairs health system before the pandemic, said lead author Dr. Allison Lin.

“The rapid switch to virtual visits for most patients kept people from dropping out of care, and telephone visits [also] played a key role,” said Lin, an addiction psychiatrist at the Ann Arbor VA in Michigan and investigator at the VA Center for Clinical Management Research.

In 2020, phone appointments significantly outnumbered video and in-person visits, the study found. Even in early 2021, phone visits made up 50% of monthly visits for vets using buprenorphine; video visits, 32%; and in-person care, 17%.

Compared to March 2019, on a monthly basis there was a 14% increase in number of vets receiving buphrenorphine treatment in February of last year. Over that same period, 6% fewer vets overall received any kind of addiction treatment.

Being online helps learn about and access some activities for older adults in rural Minnesota

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MinnPost reports…

Social well-being is essential to good health. Yet, as the COVID-19 pandemic roiled the country and upended social routines, supporting social well-being became even more challenging, including in rural areas. Social well-being was impacted most directly by the need to socially distance and isolate, and many people moved some or all their social activity online. However, this proved more challenging in rural areas, where broadband connectivity is less available and devices are less omnipresent, and for older adults, who generally report lower use of online technology than their younger counterparts.

In an April, 2022 report released by AP and NORC at the University of Chicago, rural adults age 50 and older reported the lowest level of satisfaction with available social activities in their community (only 38% thought the area they lived in was doing a good job at providing social activities, compared with 52% in urban areas and 55% in suburban areas, despite the fact that older adults make up a disproportionate share of rural residents). The survey also showed that rural residents reported lower satisfaction with transportation and availability of services to help them age in their own homes, compared with their urban and suburban counterparts.

They looked at the impact of broadband access and info…

We researched social opportunities in all 60 non-metropolitan counties in Minnesota, focusing most on those geared toward older adults. We found ample opportunities, but also variation between counties. Most – but not all – counties offer some combination of social infrastructure, including public libraries, senior centers, farmer’s markets, faith-based organizations (notably mostly Christian churches), American Legions and/or VFWs, and public parks. For some, there were community arts centers and hobby groups (e.g., quilting, fitness classes, bee keeping, cards, gardening, community theater, movie nights, bingo, photography, fishing, art classes, wine tasting, book clubs).

Some counties and communities made it easy to find opportunities online. For example, the Todd County website listed a variety of opportunities and social infrastructure resources in an accessible, user-friendly fashion. This is good for residents looking for new ways to connect with each other, but is also important for loved ones who live out of town and are trying to find opportunities for those they care about. Many counties also have local news sources through which activities and events can be shared, although the availability and independence of those has decreased nationally in recent years, potentially making it more difficult to share local social opportunities.

Other counties and communities were much more opaque about social opportunities for older adults. Either the opportunities don’t exist, or, more likely, they organize by word of mouth or other forums. That begs the question, who might that be leaving out? How would newcomers to communities learn about social opportunities and connections, and how can out-of-town loved ones help their family members find ways to connect?

Three data points to help plan for IIJA broadband funding

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The Benton Institute for Broadband and Society has come out with a helpful help report on three data points that will help plan for Infrastructure Investment and Job Acts Broadband Funding. Here are their three points…

As policymakers begin to plan how to use Infrastructure Investment and Jobs Act (IIJA) funds to increase broadband connectivity, there are three important data points from two recent surveys to keep in mind:

  1. Some 32% of households are subscription vulnerable, that is, they struggle to maintain service and have a very difficult time affording service.
  2. Only 18% of cellphone-only respondents were “very satisfied” with their online access for activities such as school or work, activities that moved online during the COVID-19 pandemic.
  3. Some 35% of households with no internet connectivity were largely unable to use outside resources (e.g., friends or community organizations) for “proxy” internet use during the pandemic.

These data points offer “do’s” and “don’ts” for broadband planners and other decisionmakers:

  • Do not think that getting people online is a one-time transaction; prepare for the long-term to provide resources to keep people online.

  • Do not expect those relying only on smartphones to effectively engage online with educational or health resources; have laptop or tablet computer distribution programs in place.

  • Do not underestimate the challenge, given how many low-income people have very limited internet experience; prepare to provide them with one-on-one help.

Telehealth Use Among Medicare Beneficiaries Multiplied by 88 during the Pandemic

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Internet Innovation reports..

Medicare beneficiaries completed 54.5 million virtual office visits in 2020, according to a new federal report released by the Department of Health and Human Services’ Office of Inspector General. The analysis considers Medicare fee-for-service claims data and Medicare Advantage encounter data from March 1, 2020, to Feb. 28, 2021, and from March 1, 2019, to Feb. 29, 2020.

The COVID-19 pandemic caused telehealth use to skyrocket. Medicare beneficiaries used 114.4 million telehealth services from March 2020 to February 2021, which is 88 times the use of these services by this population the year prior.

From March 2020 through February 2021, 43 percent of Medicare’s 66 million beneficiaries – more than 28 million people enrolled in Medicare – used a telehealth service. Prior to the pandemic, just one percent of beneficiaries used telehealth.

Researchers find connection between COVID deaths and lack of broadband

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Vox reports on the connection between COVID deaths and broadband access…

Two years into the pandemic, researchers are still trying to understand what makes some people more likely than others to die from Covid-19. Although we know some of the risk factors — like age and underlying disease — others are less obvious. Identifying them could ease our current pain, protect communities from future epidemics, and point us toward some of the societal fractures we should most urgently try to mend.

One of the more surprising answers to this question is one that appears to have a relatively straightforward solution: internet access.

This March, researchers at the University of Chicago published a study in the journal JAMA Network Open that showed one of the factors most consistently associated with a high risk of death due to Covid-19 in the US was the lack of internet access, whether broadband, dial-up, or cellular. This was regardless of other demographic risk factors like socioeconomic status, education, age, disability, rent burden, health insurance coverage, or immigration status.

The study authors estimated that for every additional 1 percent of residents in a county who have internet access, between 2.4 and six deaths per 100,000 people could be prevented, depending on the makeup of the region.

Why is lack on broadband a factor?

These inequities were not created by chance. In the US, private internet service providers developed the infrastructure for broadband internet access where it was profitable. As a consequence, many of the country’s most marginalized communities have the fewest, most expensive, and lowest-quality choices when it comes to an internet service provider.

As those access gaps persisted over the years, more and more health services came online. That left those without access unable to use telemedicine, or even easily look up information about health conditions. Over the last few years, researchers have started to see internet access, and in particular high-speed broadband, as a critical component of health — something vital for connecting people not only with health care, but also with food, housing, education, and income, all of which are considered social determinants of health.

Then, as Covid-19 pushed routine health care provider visits into the telehealth space, people without internet access — many of them already medically underserved — found health care even harder to access. Home broadband drew a sharper line than ever before between haves and have-nots; access to internet bandwidth suddenly determined access to educational instruction, economic stability, food pantry sign-ups, vaccine availability and safety information, human contact, and so many other resources.

1 in 7 Minnesotans who needed reliable broadband during pandemic, didn’t have it

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A report from APM Research Lab finds…

According to our Minnesota’s Diverse Communities Survey, only half of those from households that included someone either working from home or attending school online reported a “very reliable” internet connection. One-third indicated that their internet connection is “somewhat reliable,” with the remainder split between “slightly reliable” (9%) and not at all reliable (6%).

The survey looked a broadband access and use of broadband during the pandemic (did anyone in household work or go to school online) and cross referenced with demographic information.

Despite a large proportion of Minnesotans with reliable internet access, more than 1 in 7 Minnesotans who needed a reliable internet connection for work or school did not have one. A small but notable proportion of Asian (excluding Hmong) and White Minnesotans reported lacking an internet connection in their home.

Among those who needed the internet for work or school, a higher proportion of residents of the Twin Cities 7-country metro had a “very reliable” connection than is the case for residents of the remainder of the state. Somewhat surprisingly, a similar gap exists between those identifying as Democrats versus those identifying as either politically independent or Republican.

They found that affordability was an important as access…

Our data from the Minnesota’s Diverse Communities Survey suggests a similar conclusion. Since there is a strong correlation between education level and income, the fact that fewer Minnesotans with less education report access to reliable internet than Minnesotans with more education implies that this difference hinges on the affordability of high-speed internet.

While the state has made great progress on overall access to broadband, there is still a lot of work to do—especially in terms of affordability and adoption—before every Minnesota household and business can regularly and reliably use the internet. The reliance on internet-based schooling during the pandemic has further underscored the equity concerns at the heart of the push toward universal broadband.

Benefits of telehealth in the oncology world – for those with access

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AJMC reports on the various benefits of telemedicine in the oncology world once COVID lower barriers of reimbursement, including weather resilience…

Rajini Katipamula-Malisetti, MD, a medical oncologist and hematologist with Minnesota Oncology who practices in Coon Rapids, has seen telehealth’s usefulness up close. She spoke with Evidence-Based Oncology™ in December 2021, as the Omicron variant fueled another surge of COVID-19 cases and triggered another rise in hospitalizations.4 This happened as Minnesota reached the season when, in prior years, a wintry blast could wipe out an entire day’s schedule.

But now, schedulers at Minnesota Oncology know that if patients call to say they can’t come in because of a snowstorm, there’s a solution. “We’re just asking them to offer telehealth appointments,” Katipamula-Malisetti said. “We don’t want to cancel appointments.”

Better yet, the team can look at the forecast and proactively switch patients to telehealth appointments if a storm is coming. “It’s been really helpful,” she said.

… telemedicine reduces exposure to infection and makes staffing easier…

Having patients see their physician, social worker, or nutritionist via telehealth obviously reduces the opportunity for infection, but that’s not the only problem it solves, Katipamula-Malisetti said. Staffing shortages have emerged across health care, and Minnesota Oncology may not have staff at each clinic for every type of service. Telehealth helps address that: “There are certain specialties where we’re still leveraging telehealth significantly,” she said.

… telemedicine makes it easier to get family history when family can join the call…

Another example: a genetics session at which family history is taken—having multiple family members participate is a plus, she said. Depending on the practice or the insurer, telehealth was used for these visits even before the pandemic due to the relative scarcity of certified genetic counselors.4 She cited visits about nutrition as a third example.

The article outlines the best uses of telemedicine (based on survey results)…

The Minnesota Oncology experience with telehealth generally aligns with survey results reported at the most recent ASCO meeting, in May 2021. Only 3 types of visits were found appropriate for telehealth by more than 50% of the providers: discussions of imaging or laboratory results, chemotherapy education, and genetics counseling. More than 50% of survivors found visits on imaging or laboratory results or financial counseling to be appropriate; 90% of providers thought financial counseling was appropriate within the context of a broader visit on supportive care. Follow-up care found appropriate for telehealth by more than 50% of both providers and survivors included symptom management; for survivorship care, more than 50% of providers and survivors endorsed nutrition consultations and patient navigation via telehealth.

And notes that of course these benefits only apply when patients have access to broadband, devices and the skills to use them…

For all the positives that telehealth can offer, the question of whether all patients have the same access to technology has lingered since the start of the pandemic. The ASCO survey results showed that among survivors, 2.5% reported having no phone or no smartphone, 6.7% reported no or unreliable broadband or internet access, and 10.9% reported being uncomfortable using technology.

Telehealth proves helpful even before COVID

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Grand Rapids Herald Review reports…

Telehealth took off during the COVID-19 pandemic, and a new study shows even people with serious mental health conditions can benefit from online appointments.

The findings are good news for rural folks who live miles away from psychiatrists and psychologists.

“This study showed that patients with multiple psychiatric conditions and who also struggle with several chronic physical health problems can engage well in mental health treatment with their primary care doctors or remote mental health specialists,” said study co-author Dr. Jennifer Severe, an assistant professor of psychiatry at the University of Michigan, in Ann Arbor.

But it also showed that patients with drug problems and manic symptoms from bipolar disorder may need additional support to get started on psychotherapy or to stay with it, the researchers said.

The study was conducted before the COVID-19 pandemic, to see if people living far away from mental health care providers could benefit from telehealth services. The work was timely, given that many health care visits have moved online because of the pandemic.

Emergency Broadband Benefit Program helped low income households keep broadband but didn’t get as many new people online

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USC Annenberg has released a study of the impact of the Emergency Broadband Benefit, the low income subsidies offered to offset broadband costs near the start of the pandemic. The timing is good, as the program shifts from a temporary solution to more permanent solution – Affordable Connectivity Program (ACP). The quick gist is that it looks like it helped a lot of people stay online, but it spur more people to get online, which is unfortunate…

The EBB program was created to mitigate the short-term impact of the pandemic on the most vulnerable households, reducing the cost burden of broadband connectivity for recipients. As the program transitions into a longer-term subsidy, it is important to take stock of its impact and adjust course as needed. Overall, the findings of this study suggest there is significant room to improve program targeting and outreach efforts, as well as to facilitate enrollment procedures for key groups of potential beneficiaries.

Critically, the findings suggest that the primary impact of the EBB program was to alleviate the cost burden for households that were already connected pre-pandemic, with only modest impact in bringing new households online. Alleviating the cost burden of broadband for vulnerable households is an important policy goal, as evidence from other studies suggests that low-income households often cut on essentials expenses (such as food and clothing) to pay for Internet service. Nonetheless, for a program that offered a subsidy level over five times higher than Lifeline, uptake fell significantly below expectations. The evidence points in particular to weak demand for residential connectivity plans, despite the fact that the $50 EBB subsidy covered about 70% of the typical cost of residential broadband in the U.S.

A key task for the new ACP program is to significantly expand coverage, particularly in areas with low residential connectivity pre-pandemic. The findings in this study suggest that renewed outreach efforts are urgently needed in rural and less populated areas, among older adults, and in communities with a large share of foreign-born residents. This is consistent with findings from recent research showing that low levels of awareness about the EBB program, as well as lack of appropriate information about eligibility and the application process, depressed participation rates among key potential beneficiaries.11 Previous research also indicates that targeted outreach efforts are likely to be more effective if channeled through organizations with strong local community ties (such as schools and senior centers), and that these organizations can also play a key role by offering technical support for onboarding those with limited digital literacy.

Leveraging enrollment in other social safety net programs with high participation rates (such as SNAP, WIC and NSLP) is another key outreach strategy, albeit one that will require cross-agency collaboration and appropriate funding. Participating providers also have an important role to play in disseminating clear information about ACP program eligibility, contract terms and service pricing, a statutory mandate that the FCC should closely monitor and enforce. Minimizing enrollment procedures is also critical, as is flexibility in the documentation required to verify eligibility.

Finally, given the level of funding and the long-term duration of the ACP program, a more robust monitoring system must be put into place to evaluate the program’s cost-effectiveness on an ongoing basis. This will require more extensive data reporting from participating providers, including information about pricing, service speeds, access technology, data usage patterns, and beneficiary location at the census tract or block group level. 13 In addition, regular surveys of existing and potential ACP beneficiaries should be conducted to better understand barriers to participation and potential adjustments to key program parameters such as subsidy level, enrollment procedures, certification rules and device offerings.

Itasca County looks at the local digital divide before and after/during COVID pandemic

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Itasca County in the home county of the Blandin Foundation. KOOTASCA Community Action has created a helpful handout on the impact of the digital divide from 2019 to 2020. They have been working hard to close the gap but the divide has deepened during the pandemic…

The pandemic has only exacerbated the digital divide in Itasca County illustrated on the previous page. KOOTASCA has deployed nearly 70 hotspots alone since the beginning of the pandemic and the 4 local school districts have deployed well over 200. More than 97% of those devices have gone to families with children of all ages; however, whether it is low-income seniors and individuals in high risk populations, those now unemployed or underemployed, families with school age children, or families with children to young to go to school, the need to support working class Itascans of all backgrounds remains.

According to the rough estimates and survey information provided by the Itasca County School Districts, between 15-30% of students have needed home Internet access due to the pandemic. This is almost double pre-pandemic needs for children under age 18 (11%). The number of adults and seniors, for all community members, similarly positioned has almost certainly grown as well.

For those fortunate enough to have meaningful connectivity, it has long been clear that internet service is a key to many resources and opportunities. Now more than ever, though, it is critical to success and daily life.

The Itasca County Connected Community proposal provides an opportunity to address this tangible need with internet service and computer devices needed by Itascans, today.

KOOTASCA is ready to undertake this with our local government, school district, and community partners, as soon as possible, if approved.