Bringing primary care to school
School-based telehealth centers bridge gaps in access to care
Health systems are increasingly expanding telehealth services in the nation’s schools as a way of providing lower-cost primary care, especially in areas where transportation and clinician shortages are barriers to care.
Nationwide, there are more than 2,500 school-based health centers, 12% of which operated via telehealth prior to the pandemic, according to a study by the School-Based Health Alliance.
Due to COVID-19 resetting the baseline for telehealth utilization, more virtual services exist now, said Marcia Ward, director of the Rural Telehealth Research Center.
“For the majority of students we serve, we are their primary-care provider,” said Dr. Patricia Grinton, medical director of Atrium Health’s community-based virtual care clinics. “So we do continuity of care for those students who are vulnerable and marginalized—that’s exactly who we targeted to start this program. Many of (them) don’t have a medical home, so we can offer that.”
Partnering with Blue Cross Blue Shield of North Carolina and the Dover Foundation, Atrium Health in 2017 launched a pilot telehealth program at three North Carolina school districts.
Since its implementation, Grinton said there has been a 90% student enrollment rate resulting in several thousand telehealth appointments and a 40% reduction in emergency department visits for students that use the school-based virtual clinic.
Blessing Health System’s transition to providing telehealth at a small Missouri school district in 2019 was fairly seamless as its providers already had established relationships with the community, said Rose Ghattas, virtual health coordinator for the Quincy, Ill.based health system.
Palmyra School District, situated in a farming and factory-centered community with scarce access to transportation, consists of three schools that share two nurses.
“We wanted (the community to) have telehealth as a backup, so they can always have reliable healthcare and not have situations like we see in other districts where administrators might have to drive a student to an appointment, or the student just goes without healthcare,” Ghattas said.
To create a platform that would allow the nurses to travel between schools to proctor telehealth visits, Blessing
“It’s the way to bring specialists, clinicians and caregivers to an environment.” Joe Devivo, president of hospitals and health systems with Teladoc Health
partnered with Teladoc Health.
Using laptops with Teladoc software and USB attachments including a stethoscope, otoscope and dermatoscope, nurses are able to share data with remote physicians in a secure and compliant way, said Joe Devivo, president of hospitals and health systems with Teladoc.
“(It) allows a location not in the normal clinical pathway to all of a sudden be one,” Devivo said. “It’s the way to bring specialists, clinicians and caregivers to an environment.”
School nurses assess whether a student’s condition warrants a telehealth visit, Ghattas said, and a guardian is called for permission to initiate an appointment.
During the telehealth visit, the provider logs on to their access software at the clinic and the nurse helps the clinician survey the student using high-resolution camera attachments. Following the virtual visit, the provider then contacts the guardian about any follow-up instructions, necessary prescriptions or future appointments.
Appointment costs are billed to insurers, and uninsured students are offered sliding scale fees, Ghattas said. School district employees pay a flat fee of $35 for nurse practitioner care and $45 for an appointment with a medical doctor.
In telehealth, there is no one-sizefits-all, and it’s important to ensure that a program works well for all involved, Ward said.
“How are you going to set up a service, staff it at your hub, so that it meets the needs of the students, teachers and administrators at those schools?” she said.
Provider reimbursement, credentialing, broadband and internet access and state regulations for medical licensure are all chronic barriers to telehealth services, Ward added.
A major consideration when creating school-based virtual care centers will be whether policies allowing Medicaid to reimburse states for telehealth services and HIPAA guideline updates will become permanent following the pandemic, Ward said.
Atrium Health received financial help from Kohl’s Cares grants, and was awarded a grant from the North Carolina Department of Health and Human Services to operationalize a teletherapy component within Kannapolis (N.C.) City Schools for the 2021-22 academic year, Grinton said.
Besides internet access, another barrier Blessing Health faced was educating the community on what telehealth is.
Ghattas said the organization walked nurses through the process of proctoring a telehealth appointment so they felt supported, circulated an educational video during parent-teacher conferences, and participated in a “Teddy Bear Clinic” to ease elementary students’ fears about healthcare.
Blessing officials also had to determine how to add in behavioral health, and what privacy would look like in terms of physical settings and who is involved in a student’s care.
Going forward, Blessing hopes to expand its program to other school districts and offer services to other
n communities, Ghattas said.