ORHPC Spotlight on Telehealth - Minnesota Department of Health

Minnesota’s Health Care Providers Embrace Telemedicine

For years, health policy experts have viewed telemedicine as a promising possibility. For seniors lacking adequate transportation—or rural Minnesotans who might need to drive long distances across snowy roads during a Minnesota January—experts saw great potential in providing efficient, safe, care that could be accessed remotely. Yet as late as 2019, telemedicine had yet to really take off. At that time, roughly only one out of four providers were using telemedicine to treat or diagnose patients—and more than half of those were using it only “occasionally,” according to the 2019 Minnesota Healthcare Workforce Survey.

Then COVID–19 hit.

Virtually overnight, the idea of telemedicine became reality.

Telemedicine takes off

Faced with the alternative of closing down, huge swaths of Minnesota’s health care providers chose to invest in their telemedicine infrastructure and take up the telemedicine mantle. This allowed them to narrow the gap between care that was still needed and executive orders to delay or cancel any in-person care. During the months of May through August of 2020—the first major COVID spike in Minnesota—more than one-third of providers reported that their workplace obtained a telemedicine platform, and another third reported that they were expanding their use of an existing telemedicine platform. Nearly 40 percent of providers reported that they were using telemedicine to provide care, and more than half of those were providing the majority of care through this new modality, accounting for a massive expansion in the overall share of clinical encounters in Minnesota almost overnight.

Perhaps unsurprisingly, the group most likely to move to telemedicine was mental health providers. More than 60 percent of mental and behavioral health providers—including licensed professional counselors, marriage and family therapists, psychologists, social workers, and substance abuse counselors—moved to this mode within the first six months of the pandemic (see Table below). Three quarters of these professionals provided half or more of the care they offered via a computer screen.

Is telehealth working?

Does telemedicine live up to the hype? The answer to this question, based on MDH’s survey responses, is a qualified “yes.” Minnesota’s health care providers say that for many types of clinical visits and patients, the new modality works quite well. It does indeed expand access in a wide variety of situations.

Inequities do exist

Yet, there’s more work to be done. In addition to expanding care, telehealth exposes some longstanding inequities. For example, providers report that for patients for whom English is not the first language, telemedicine can be quite challenging. “It’s a very difficult platform for non-English speaking families [who are working with English-only providers],” said one provider. Others report that including an interpreter can be difficult or frustrating for both patients and providers, and in some cases there is no interpreter available to speak the necessary language.

Likewise, low–income patients or elderly patients who lack the necessary technology or experience may struggle to access telemedicine. “Most patients in my practice (seniors) do not have access or cannot use internet applications for a video telehealth visit,” said one provider. Another reported that it was difficult to treat low-income and homeless patients, saying, “they need access to both a computer, and to MyChart, and they [often] don’t have that.”

And although many providers reported how helpful telemedicine could be for reaching their rural patients, unreliable internet access in remote areas of the state also created problems. Many providers reported that poor connections limited their ability to effectively work with and treat their rural patients. As one provider noted, “For those of us in rural areas it has been a health access game changer, supporting greater health equity. But it doesn’t work when our families have limited or no access to the internet, and this will require ongoing attention from policymakers.”

While the overnight telemedicine experiment has revealed weaknesses in some areas, what seems clear from the provider perspective is that telemedicine is here to stay. Among those who are currently using telemedicine to provide care, nearly 90 percent say they plan to continue using it either sometimes (60 percent) or frequently (26 percent) after the pandemic has passed. As one provider put it: “It works. And it does remove barriers for patients who have difficulty coming to see me in person.”

Conclusion

Consumer preferences for flexible, on-demand, virtual care also seemed to have evolved overnight. The health care community will be watching to see if these preferences stick post-COVID, and if the temporary changes to reimbursement policies remain in place. If they do, remote care is almost certainly here to stay.

More information

For more information on the Minnesota Healthcare Workforce COVID survey, please visit our web site at Health Care Provider COVID Survey https://www.health.state.mn.us/data/workforce/covidsurvey/index.html

To learn more about the changes in coverage and reimbursement for telemedicine services, visit:

• Recent temporary changes in coverage/reimbursement of telemedicine for Medicare, MHCP, and insurers subject to MN §62A.671 (PDF)

• The Great Plains Telehealth Resource and Assistance Center - https://www.gptrac.org/

Listen to podcast: The effect of COVID on Minnesota's healthcare workforce (30 minutes)

Contact: Senior Research Analyst Teri Fritsma, Office of Rural Health and Primary Care, Minnesota Department of Health