This article is part of State of Health, a series about how Michigan communities are rising to address health challenges. It is made possible with funding from the Michigan Health Endowment Fund.

Health care visits conducted by phone or videoconference had slowly started to catch on in Michigan in recent years, but telehealth has surged since it’s become the safest way for health care providers to meet with their patients during the COVID-19 pandemic.
 

Before the pandemic, Cherry Health had initiated a limited, grant-funded telehealth program to provide behavioral health to patients of its rural clinics in Montcalm, Berry, and Eaton counties. Since COVID-19 hit, more than 80% of its behavioral health and medical visits have been conducted via telehealth. Cherry Health providers are now doing more than 800 virtual visits a day.

“That change occurred in the span of a week,” says Dr. Leslie Pelkey, Cherry Health’s chief medical officer. “… We did a lot of work in a short time. It really wasn’t as hard as we thought. There are always barriers to change, but when you can get down and do it, you realize it is possible.”

Leslie Pelkey.

Blood pressure cuffs were safely delivered to patients with chronic hypertension so they can share data with providers who advise and adjust medications accordingly. Patients with diabetes can do drive-through testing and follow up with telemedicine. Using telehealth exam tools, providers can address COVID-19 infection as well as issues like musculoskeletal injuries and abdominal pain. Providers are also completing mental health screenings for depression and substance abuse.

“These visits also allow providers to check in on families who are feeling huge stress in having to be responsible for educating their kids at home,” Pelkey says. “We give guidance and support and assess if they have other needs … like access to food [or] housing.”

Those in the health care world realized early on that telehealth could be especially effective in reaching patients with income challenges and those impacted by social determinants of health. Cherry Health counts many people of color among the patients it serves. Because COVID-19 is having such a devastating impact on Michigan’s communities of color, finding ways to continue their care is extremely important.

“Telemedicine has the potential to increase access to care for those who have significant barriers,” Pelkey says.

Due to the “extremely positive feedback” she’s heard from both patients and staff members, Pelkey foresees providers extending their use of telehealth beyond primary care to include collaborations with specialists.

“Before the pandemic, I actually had sent out a questionnaire for all providers to see whether there was interest in telehealth,” she says. “25% said they’d be willing to give it a try. Now 100% are doing it.”

Behavioral telehealth: 'absolutely imperative'

Telehealth has proven especially vital for Michigan’s behavioral health providers during the pandemic. Like Cherry Health, Auburn Hills-based Easterseals Michigan had embarked on a small telehealth program before the pandemic, enlisting 20 intake and outreach staff. A large part of the organization’s work centers on behavioral health care for children and adults, supporting recovery from serious mental illness and substance abuse. During the first week of the COVID-19 stay-home order, the organization rallied 300 staff members to provide telehealth services to clients.

“Most of the staff love it,” says Brent Wirth, president and CEO of Easterseals Michigan. “They’re not driving to work. No-shows are way down. Clients don’t have to worry about transportation issues. Most of the people we serve have Medicaid and don’t have reliable transportation.”

Like Easterseals Michigan, Grand Rapids-based Arbor Circle has found telehealth to be extremely useful in providing behavioral health care during the pandemic. Arbor Circle hadn’t used the technology much before the pandemic, mainly because private insurance and Medicaid weren’t reimbursing for it. With payors making exceptions due to the pandemic, Arbor Circle’s providers are handling 80% of their 4,000 open cases via phone and videoconference.

Arbor Circle therapist Marvin Mckenzie simulates a telehealth visit with a colleague.

“We do a lot of stuff in a lot of different places. Certainly, we were doing tons of work with our clients on the phone. We just did not have a mechanism to get reimbursed for it,” says Kristin Gietzen, president and CEO Arbor Circle. “Overall, our clients are telling us that they are really relieved that this is available.”

Kristin Gietzen.

While Easterseals continues face-to-face services with its high-risk clients, telehealth options have ensured continued care for thousands of people who would have otherwise lost access to services.

“If their care was cut off, we would have massive hospitalizations. Things would be really chaotic,” says Dr. Duren Gutierrez, a psychiatric mental health nurse practitioner with Easterseals Michigan. “Some would put themselves at harm … [or] in some cases, cause harm to others. It’s a very, very important [part] that we’re playing right now. It’s absolutely imperative.”

Using telehealth, Gutierrez is able to make sure his patients are taking their medications, getting adjustments to medications if needed, and not putting themselves at risk for recurrence of serious symptoms or hospitalization.

“The benefits have been really tremendous,” he says.

In addition to individual behavioral health consultations, Easterseals Michigan is also offering speech, occupational, and group therapy via telehealth.

“We always talked about using telehealth more,” Wirth says. “We had the technology and we knew we needed to force the culture to change. COVID forced that cultural change and we’ve adapted.”

Challenges remain

While telehealth has overall proven extremely successful in expanding access to care during the pandemic, challenges remain. Wirth says Easterseals Michigan will always offer face-to-face appointments for those who want them, but about 20% of its patients don’t have technology to access a telehealth appointment even if they wanted to.

“That’s a lot of people that don’t,” he says. “… It’s been great for many people but it’s not the answer for everyone.”

Like Easterseals, many of Arbor Circle’s clients face income challenges that affect their ability to access telehealth. In addition, some of the rural communities Arbor Circle serves do not have consistent internet access.

“We are trying to figure out how to serve them best,” Gietzen says. “We feel really thankful that many of our payors are allowing us to do phone-only visits and not requiring videoconferencing. But many people only have so many minutes on their phone. They’ve got to spread out their paycheck for food and housing. It’s like a double, triple, quadruple whammy.”

While COVID-19 has ushered in a new era for telehealth, the same barriers causing healthcare disparities in Michigan remain. Phone and WiFi access now join the list of social determinants of health that prevent people with income challenges, most often people of color, from achieving health equity.

“We’re feeling very grateful that we have been able to do as much as we have. But so much more needs to be done,” Gietzen says. “As we move into the [COVID-19] recovery stage, the needs are just going to explode. I am hoping that payors are all learning that telehealth needs to be a tool in the toolbox.”

A freelance writer and editor, Estelle Slootmaker is happiest writing about social justice, wellness, and the arts. She is development news editor for Rapid Growth Media, communications manager for Our Kitchen Table, and chairs The Tree Amigos, City of Wyoming Tree Commission. Her finest accomplishment is her five amazing adult children. You can contact Estelle at [email protected] or www.constellations.biz.

Photos by Bud Kibby.