Rural America is perhaps the place that needs telehealth the most. However, rural health systems face a slew of challenges when it comes to establishing far-reaching virtual care programs — from spotty broadband connectivity to reimbursement trouble to a lack of patient awareness.

Sanford Health, the largest rural health system in the country, held a conference last week to discuss how rural providers can weather the obstacles they face and create resilient telehealth and remote patient monitoring models of care. Panelists Jim Weinstein, Microsoft’s senior vice president of health equity and innovation, and Sheri Dodd, vice president and general manager of Medtronic Care Management Services, detailed three rules rural providers should keep in mind when moving forward with virtual care.

Let data guide you

Weinstein conceded that virtual care, just as any other healthcare, is confusing and complex — and health systems haven’t quite figured out how to master its delivery. As consumer-friendly companies like Amazon and CVS Health swoop in to offer patients across the country with more convenient and accessible care, he thinks the healthcare industry should start smaller. He argued that the real virtual care champions should be rural providers. 

Believing that rural providers have specific population health data that can inform the strategic design of effective virtual care programs, Weinstein said these providers should begin by mapping county-level data to quantitate virtual care model’s effectiveness for certain rural populations. He deemed this a crucial step that can ensure virtual care outreach is targeted to patients who would benefit most, such as Millenials with chronic conditions, instead of “throwing stuff at the wall to see what sticks.”

Optimizing EHR data is becoming even more important as rural health system’s revenue streams become increasingly compromised, Weinstein pointed out. He called upon rural providers to utilize local data to determine specific patient needs, design programs based on that data and watch usage rates closely, and then gradually expand their programs based on the feedback they receive. 

Make room for VBC exploration

As rural providers establish and scale virtual care programs, Dodd pointed out that they need to be cognizant of how challenging success will be in a fee-for-service environment. First, fee-for-service reimbursement is typically calculated by a fax machine — valuations can be tough because this model is not built for digital. The second reason Dodd cited is that many fee-for-service reimbursement models are reliant on patient engagement. In order to reimburse remote patient monitoring, she said some payers require providers to prove that patients are compliant 20 days per month.

“If you are developing a reimbursement model with external people on remote monitoring, and you’ve got 20% of the population who doesn’t do day 20, you get zero reimbursement for that month,” Dodd said. “So what I would hate to have happen is that we get over reliant on a fee-for-service reimbursement construct because there’s this whole patient engagement piece. This can sour the use of technology because in the end, the money doesn’t come through.”

Dodd believes value-based healthcare models are a better fit for rural virtual care and called upon health plans to experiment with these care models sooner rather than later. She said the healthcare system urgently needs to figure out how to optimize value based care for virtual care delivery models, pointing out that “integrated delivery networks are the prime golden opportunity for experimentation.” 

Prioritize personalization

Dodd said sees more than 90% of remote patient monitoring programs “fail outright.” The ones that do succeed — she named the Department of Veterans Affairs’s remote monitoring program as a rare outlier — look at patients’ total needs. This means not only looking at patients as more than a single disease state, but also considering all their preferences, such as their communication styles or what time of the day they like to connect with their caregivers.

Medtronic supplied the majority of the remote patient monitoring technology the VA uses in its virtual care program, and she said a big reason the program is successful is because it accounted for the different technologies each veteran prefers. For example, some veterans find wearables uncomfortable, and some like receiving their care plan via app rather than a call with their doctor.

Personalized care usually leads to better health engagement and therefore better outcomes, according to Dodd. In order for rural virtual care programs to be personalized, she said providers must pay attention to which technologies work best among their patient populations. 

Photo: Maria Symchych-Navrotska, Getty Images