Is Telehealth the Solution? Reimagining Community Health Systems

As frontline workers during the COVID-19 pandemic, the care teams of Iowa’s community health centers — who are also members of the Iowa Primary Care Association (Iowa PCA) — have been in a pitched battle to provide testing and, most recently, vaccines to the 226,000 Iowans who rely on the network’s community health centers for care.

“Health equity for all” is the mission of the Iowa PCA, which provides care and services to underserved populations through a statewide network of 14 community health centers.

This spring, thanks to valuable insights from the cross-corporate teams that volunteered their skills for the Reimagining Community Health Systems Challenge, administrators at the Iowa PCA will be heading into their statewide strategic growth planning sessions with an innovative, comprehensive vision for integrating telehealth services into its plans for an electronic health records system. By optimizing telehealth services, the Iowa PCA aims to improve access and clinical outcomes for patients and connect them to an evolving model of care that maintains quality, enhances health equity, and lowers costs.

“We benefited a ton from having plans, ideas, innovation, and things we could try from a perspective that is much broader than the pandemic,” says Sarah Dixon, senior director of Partnerships and Development at Iowa PCA. “The teams did in one month something that would take us a year to do. In terms of the rapidness of the response, thoroughness, and comprehensiveness, it was really an amazing experience for advancing our work.”

Community Health Centers in the United States

Community health centers are the primary source of healthcare for about 30 million Americans of varied ages, income levels, and insurance status. They serve urban and rural populations, including the homeless, school-age children, families, veterans, agricultural workers, migrants, refugees, public housing residents, and walk-ins. Services typically include managing chronic illnesses like heart and lung disease, diabetes, hypertension, and childhood asthma. The health centers also provide behavioral health services and substance abuse treatment. The managerial boards are largely run by consumers of health center services, making this the only patient-run healthcare system in the United States.

Cross-Corporate Teams Innovate for Social Impact

As a cross-corporate volunteer competition, the Reimagining Community Health Systems Challenge brought together diversified teams of skilled professionals to apply their expertise to formulating bold solutions to complex challenges on behalf of public sector organizations that have potential to make an impact on social, economic, or environmental problems. Organized by PYXERA Global, an organization that brings together the public, private, and social sector to address global challenges, the challenge ran from May through September 2020 as part of a larger Reimagine Series of social impact challenges designed to find innovative solutions to longstanding societal concerns that have been made worse by the COVID-19 pandemic.

Reimagine Series | The Multiple Perspectives of the Reimagining Community Health Systems

SAP took an active role as a lead corporate sponsor, along with Medtronic Foundation, a charitable organization funded solely by global medical technology company Medtronic. Medical device maker BD and Celanese, the chemicals and specialty materials company, also joined the challenge to advance health equity through telehealth. Altogether, these industry partners selected 40 employee volunteers distributed across three continents to participate in the challenge, which was held virtually. The volunteers were organized into eight cross-corporate teams in a collaborative competition to see which team could develop the most innovative solution to the challenges proposed by two public sector organizations, called Anchor Partners.

The key advantage of cross-corporate teams is the outside-in approach that they bring to problem solving. This diversity of thought leads to creative, comprehensive, and cost-effective solutions for growth-oriented, not-for-profit organizations, which often lack internal resources for strategic business planning.

“Multi-company teams add a unique dimension of diversity to a global pro bono program, as participants bring their personal experiences, tools, methodologies, and corporate culture to the table,” says Hemang Desai, global program director for Corporate Social Responsibility at SAP. “These elements result in innovative and impactful solutions to the business challenge presented to the teams, while creating a rich, multi-faceted learning experience for the participants as they build strong people connections in the business world.”

The two Anchor Partners in the challenge were the Iowa PCA and the National Association of Community Health Centers (NACHC). In its challenge statement, the Iowa PCA sought input for a framework to roll-out and integrate telehealth across its network of community health centers. The challenge from NACHC differed in that it sought broader guidance on how to create a clear role and business plan to position itself in the telehealth landscape as a leader for community health centers on a national level. With the pandemic accelerating, both organizations were motivated by the pressing need to realistically assess the potential for telehealth to expand access to care.

Jason Patnosh, associate vice president of NACHC, recalled the urgency NACHC faced during the lockdowns in early March. “For the first time, outside of natural disasters, health centers had to close their doors to patients for the safety of their staff. This meant they had to find alternatives to reaching out to some of their most vulnerable patients,” Patnosh said during a Reimagine Series webinar.

Telehealth Expands Care Access

Telehealth is rapidly becoming the go-to solution for millions of Americans seeking routine medical care and management of chronic illnesses. The COVID-19 pandemic, overshadowed by lockdowns and social distancing precautions, has accelerated the adoption of telehealth as an alternative to traditional in-person visits to care providers. For underserved populations – especially the elderly, rural residents, and low-income patients – COVID-19 has exasperated the already limited access to care and services further.

Before COVID-19, telehealth accounted for a mere 0.1% of primary care visits for patients with traditional Medicare, a government healthcare program that covers 60 million Americans, including those 65 and older and disabled adults. However, during the lockdowns, the percentage of telehealth appointments climbed to more than 40%, according to data cited in the Washington Post.

Addressing Long Journey Times and Broadband Access

The eight teams prepared for the challenge by talking to stakeholders and studying policy information. In August, they got down to business tackling the four project phases: Discover, Ideate, Create, and Deliver.

Fouad Sadik, an SAP development architect, worked on the challenge for the Iowa PCA as the lead for the Tele-Transformers team. Sadik is an SAP volunteer ambassador who has worked on cross-corporate teams in the past and sees many advantages to this problem-solving approach. “The community health centers benefit from tapping into the diversity of the skill sets coming from multi-company knowledge,” Sadik says. “Being a member of a team of five allowed us to divide and conquer the deliverables according to each member’s skill set to get the best outcome.”

Sadik’s team analyzed stakeholders’ perspectives from healthcare professions and view-of-the-customer interviews to gain a comprehensive understanding of the issues surrounding telehealth adoption for the Iowa PCA. They also spoke with insurers and the presidents of Iowa’s two Medicaid Managed Care Organizations to ensure alignment on the reimbursement models for telehealth services. To better understand issues affecting different patient populations, the team developed detailed personas and undertook geo-mapping to analyze patient journey times to care centers. Strikingly, they discovered that some patients were traveling more than three-and-a-half hours to access care. This led the team to make recommendations for co-hosted telehealth sites with other organizations, like libraries or schools, that could serve as access points for telehealth services.

Dixon says it is a recommendation that the Iowa PCA will investigate further. “Telehealth may allow us to go into some communities where a full clinic site isn’t viable, but telehealth in partnership with another community provider could be a really viable way to increase services. We’ll be looking at that as part of our statewide strategic growth planning this spring.”

Digital broadband connectivity remains a hurdle across much of the state of Iowa. To address this imperative need, the Iowa PCA is part of a coalition of schools, libraries, and rural economic development agencies that are working on securing broadband infrastructure across the state. The teams developed innovative ideas for extending phone signals, expanding digital footprints to include parking lots for mobile telehealth vehicles, telehealth ATM machines in hotspot locations, and broadband sharing with other community and civic centers.

Empowering Patient Access and Satisfaction

At the end of the challenge, judges chose two winning proposals based on six criteria: innovation, social impact, sustainability, desirability, feasibility, and viability. The Tele-Transformers team, led by Sadik, won the challenge for the Iowa PCA, presenting a comprehensive telehealth program based on three pillars: strategy and process improvement, marketing and training for both patients and care providers, and technology systems and software. The team provided a detailed software comparison list of 14 telehealth software providers and six learning management systems, allowing them to make a recommendation for a strategy and unified approach that uses a common platform. Sustainability, social impact, and empathy for end users played a large role in the team’s proposal, which also included recommendations for expanding telehealth services for mental health, behavioral, and chronic care.

As a participant, Sadik says he benefited professionally from exposure to the healthcare domain, design thinking sessions, and project management methodology, while attaining personal development by helping the Iowa PCA expand care access for patients. “This challenge made an impact toward the refinement of existing processes, building a road map for telehealth business programs and providing a digital footprint for telehealth on a grassroots level close to affected communities,” Sadik says, adding, “that’s actually the challenge by itself that allowed us to improve telehealth systems and empower patients’ access and satisfaction.”

The winning team for the NACHC Challenge was R/Evolution, which emphasized establishing best practices and using strategic partnerships and data analytics to elevate NACHC’s leadership on telehealth.

For Suzie Moskal, senior IT manager at Medtronic, participating in the challenge on behalf of NACHC was a rewarding experience that she would recommend for future participants considering the estimated four hours per-week time commitment. “I would say definitely do it, make the time to make it happen. When I looked at the pitch session and saw all the amazing ideas and concepts that NACHC was going to receive, I was excited for them. Whether my team won or not, they got a very amazing set of products out of this experience.”

To see all of the concepts that were presented, view the Reimagining Community Health Systems Challenge Report.

Care Access Enhanced by Technology

NACHC is moving ahead with due diligence to operationalize not only the winning concept but also integrate positive aspects of the other solutions. Its staff is engaging in further ideation sessions with PYXERA Global to refine the solutions and create a version to put into action.

Patnosh sees clear value in having participated in the Reimagine Series: “To get the amount of input that we had from the teams and to have that level of engagement, and then also the quality of the presentations that come in, we estimate that those would have probably been 50 to 75 thousand-dollar engagements just with each team, if we were to contract that out.”

Following the challenge, the Iowa PCA has shifted its plans away from implementing a standalone e-health platform. Feedback from the teams and voice-of-the-customer interviews convinced the Iowa PCA of the need for a simplified, integrated e-health solution that is easy for everyone to use. The organization is currently evaluating new electronic health records systems with a strategic focus on integrated telehealth functions.

Dixon says, “The insight from the challenge was so important because it brought in a different voice – a voice that wants the same things we do: simple tools, the ability to access information at our fingertips, and have a workflow that is enhanced by technology, not negatively impacted by technology.”