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.
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.
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?
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:
- Some 32% of households are subscription vulnerable, that is, they struggle to maintain service and have a very difficult time affording service.
- 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.
- 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.
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.
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.
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.
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 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.
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 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.
The FCC reports…
—The Federal Communications Commission today announced that it is committing $602,985,895.13 in its latest wave of Emergency Connectivity Fund program support, which will connect over 1.4 million students in all 50 states, Puerto Rico, and the District of Columbia. These additional commitments bring the current total commitments to over $3.8 billion, supporting students, school staff, and library patrons in all 50 states, Guam, Puerto Rico, the U.S. Virgin Islands, and the District of Columbia. The funding can be used to support off-campus learning, such as nightly homework and virtual learning, as schools and libraries continue to respond to the ongoing COVID-19 pandemic. …
Today’s announcement marks the sixth wave of commitments and includes over $367 million in commitments from Window 1 applications and nearly $236 million in commitments from Window 2 applications. This round of commitments will support 1,651 schools, 85 libraries, and 14 consortia, which are approved to receive nearly 1.2 million connected devices and over 790,000 broadband connections. Total commitments to date are supporting over 9,000 schools, 760 libraries, and 100 consortia for nearly 8.3 million connected devices and over 4.4 million broadband connections. More details about which schools and libraries have received funding commitments can be found at https://www.fcc.gov/ecf-current-funding-commitments.
Minnesota will get $57,412,673.35 in total doled out in waves of:
The folks who manage Universal Service and the Emergency Broadband Benefit (EBB) programs just published a report on EBB, the fund established during the COVID pandemic to subsidize broadband access to make it more affordable to households that needed that help. In Minnesota, 76,301 households have signed up for EBB.
Here are some of the other stats…
The MN Broadband Task Force sent a letter to Governor Walz, Speaker of the House Melissa Hortman, Senator Erin Murphy, and Representative Debra Kiel…
As part of the American Rescue Plan Act funding that Minnesota is slated to receive, there is a Sec. 604
Coronavirus Capital Projects Fund that is intended to be used “to carry out critical capital projects directly enabling work, education, and health monitoring, including remote options, in response to the public health emergency with respect to the Coronavirus Disease (COVID-19).” The U.S. Department of the Treasury (Treasury), which is charged with administering this fund, notes on its website that a
purpose of this funding is to “contribute to the Administration’s goal of providing every American with
the modern infrastructure necessary to access critical services, including a high-quality and affordable
broadband internet connection.”
In August 2021, Treasury identified the amount of Sec. 604 funding that would be allocated to each state; Minnesota’s allocation is $180,702,620. In September 2021, Treasury issued guidance as to how the Capital Projects Fund dollars may be used and broadband infrastructure projects were identified as a presumptively eligible use.
In the 2021 Minnesota legislative session, language was passed to fund the state’s Border-to-Border Broadband Infrastructure Grant program with $70 million over the biennium and with that funding coming from the Capital Projects Fund. This decision was made prior to either information being released regarding Minnesota’s total allocation or guidance on allowed uses.
Minnesota is required to apply for this funding by December 27, 2021 and once its application is
approved and an agreement signed with Treasury, the state must submit a Grant Plan and a Program Plan(s) outlining how it intends to use the state’s allocation of $180,702,620. The Governor’s Task Force on Broadband would urge the state to submit its application as soon as possible and once an agreement is in place, file a Grant Plan and Program Plan to use all the funding for the state’s Border-to-Border
Broadband Infrastructure grant program. With prompt approval by Treasury, the Office of Broadband
Development could then open a grant window and approve projects in time to be built, or at least started, during the 2022 construction season. As you are aware, Minnesota’s construction season is shortened due to weather and it is imperative to get the ball rolling as soon as possible.
The guidance issued by Treasury indicates that any home or business in Minnesota that does not have a reliable, wireline broadband service of at least 100Mbps download and 20Mbps upload is eligible for this funding. The latest data available shows that there are at least 240,000 households in Minnesota without a broadband connection meeting those speeds. Assuming an average cost of $5,527 per location to deliver a broadband service (taken from the Task Force’s 2020 annual report), deploying service to those 240,000 households would require funding of over $1.3 billion. Even assuming the grant portion for that funding is capped at 50 percent as it is under current state law for the Border-to-Border Broadband grant program, funding of $663 million would still be necessary.
While Minnesota has been a leader amongst the states with its Border-to-Border Broadband Infrastructure grant program having awarded $126.2 million to reach approximately 57,000 locations with broadband service between 2014 and 2020, the state is falling behind. In March 2021, Wisconsin awarded over $24.8 million for 58 projects, in October 2021 Wisconsin awarded $100 million to 83 projects and in early November announced that the next grant window to award another $100 million will open December 1, 2021. In October 2021, Iowa announced that it would make available another $200 million for broadband grants in addition to the $100 million in grants announced in September 2021 as part of its Empower Rural Iowa Broadband Grant Program. A few other examples include Missouri announcing it will use at least $400 million for broadband infrastructure; Ohio is using $250
million to improve high speed internet service; Texas Governor Abbott just signed a bill allocating $500
million for broadband infrastructure; and Virginia has plans to use $700 million to provide universal
broadband by 2024.
The pandemic has made clear the need for fast, reliable broadband service to all homes and businesses in the state. Federal funding is available to get that infrastructure deployed. Broadband is the foundational element that is a force multiplier for all other issues. We need it to better address critical challenges and build economic opportunity, competitiveness, and prosperity. The state has in place a
nationally recognized broadband office and grant program. All that is needed is for the Governor and
the Legislature to direct the available federal funding to the Border-to-Border Broadband Infrastructure grant program so that the real work of building out the infrastructure to meet the state’s broadband
goals can be achieved. The time is now to invest in our communities.
Thank you for your prompt consideration of this request.
Chair, Governor’s Broadband Task Force
St. Paul’s Regions Hospital is receiving $1 million of federal funding for telehealth services.
The funding comes from the Federal Communications Commission’s COVID-19 Telehealth Program, Senators Amy Klobuchar and Tina Smith announced Thursday. It will be used to buy a remote patient care telehealth platform.
“The pandemic has shown us how telehealth services have been a lifeline for patients across Minnesota who may otherwise not be able to access the health care they need,” said Smith in the press release. “This funding will help Regions Hospital continue to use telehealth to make health care accessible to patients who are unable to get services in person.”
Along with the $1 million for Regions Hospital, Klobuchar and Smith secured funding for the expansion of telehealth services for these health providers in Minnesota:
- $21,533 for Native American Community Clinic in Minneapolis
- $498,818 for Minnesota Community Care in St. Paul
- $234,352 for CentraCare Health System, the largest provider for rural Minnesota communities
- $120,305 for Nett Lake Health Services in northern Minnesota
- $981,204 for Essentia Health in Duluth
The funds will allow providers to expand patient access by purchasing more telehealth equipment like laptops and monitoring devices, as well as increase wireless broadband coverage at several clinics.