Transformative events often yield remarkable results. Just as the Civil Rights movement inspired the creation of community health hubs, today’s Federally Qualified Health Centers are at the crux of a care crossroads. The pandemic has thrust into the spotlight America’s healthcare disparities as some of the most at-risk patients face reductions in face-to-face services — an issue Dr. Patrice Harris, the immediate past president of the American Medical Association (AMA), recently discussed with athenahealth.

But the crisis has also emphasized opportunities to evolve, say three leaders in COVID-19 hotspots. Jeff McInnes, director of billing and patient access at Chicago’s Esperanza Health Centers, Diego Shmuels, chief quality officer at Miami’s Borinquen Medical Centers, and Douglas York, CEO at Union Community Health Center in the Bronx, shared their insights as part of Healthcare’s Next Act, a recent two-day virtual event discussing the future of care post-pandemic. The trio’s strategies include engaging their patient populations and utilizing technology to the fullest in order to maintain essential care during this trying time — and beyond. 

Creative solutions to increasing access 

For many providers and well-to-do patients, virtual care has more than bridged a pandemic gap, it’s broadened ongoing engagement options. But for other more vulnerable populations, lack of Internet access, hesitation to show a health professional their living environment, and a lack of technical literacy may exacerbate chasms in care. Shmuels says those challenges are magnified in Miami with homelessness and a large Hispanic population worried about being identified by immigration services. 

“Trying to open or download and app, having a webcam, causes a lot of limitations,” he explained. “A lot of patients don’t want to show their house or where they are, either.” 

New rules requiring not just audio but visuals for telemedicine for reimbursement are another reason his organization thought outside the box to combat access issues. Their creative solution includes in-person hubs at clinics for patients who live nearby to use consoles and virtually visit specialists from other sites who are further away. This helps with the city’s public-transportation issues, too, as Shmuels says getting to appointments can take up to two hours.

At Esperanza, McInnis says his organization has used free patient ride-shares to get them to appointments and that Medicaid also offers transportation options. He says transitioning to telehealth has enhanced patient engagement among a population that was previously challenged because they are likely not salaried – meaning every hour visiting a doctor is an hour they are losing income. “Our patients don't have time to come into the clinic and spend several hours sitting in the waiting room, seeing the provider, waiting for labs. That increases no-show rates and makes patients less likely to engage in their care,” said McInnis. “For us, the ability to have same-day telehealth access has been really transformative.”

Esperanza’s no-show rates previously hovered around 35%, but no-shows along with same-day cancelations dropped to below 10% since the addition of the telehealth option in the spring. They are able to continue seeing the same number of patients, if not more, and have hired additional providers due to demand. 

Telehealth enables a holistic view of the patient 

Telehealth has helped transition medicine out of more traditional episodic approaches to healthcare, and enable a more holistic patient view for some of the most at-risk populations. At Esperanza, that’s been as simple as a provider walking one of her long-time patients through how to use a glucometer properly during a virtual care visit, and includes asking patients to open up their refrigerators to get insights on eating habits. 

Across all of the panelists’ organizations, telehealth has enabled patients to invite family members or caregivers, and to sustain relationships virtually. “The family aspect of care is so important. In our communities, a healthcare visit used to be a family outing, but in this climate, it’s not,” said York. In that regard, telehealth has offered more options than in-person visits. 

A Family Fit Club sponsored by Borinquen Medical encourages more than showing up for appointments, it’s about inspiring healthy habits for entire households. Shmuels goes a step further to say how enthused his organization is for the opportunities to virtually connect several caregivers across settings that otherwise would have been difficult to schedule in-person. “Not only have we been capable of avoiding the silos within the different departments, we've been able to be more integrated and create a more holistic approach with providers,” he explained. “We have a nutritionist. We have a behavioral health counselor. We have a psychiatrist. We have a pediatrician. So we're being able to do a more team approach to be successful in those visits.”

Outreach efforts have improved 

The COVID crisis has motivated many organizations serving at-risk populations to enhance ongoing outreach efforts. While there have been some bright spots, there is still much work to be done — especially as the pandemic stretches on. In the Bronx, this is just as much about addressing mental health needs as physical ones. A “massive” campaign starting in March addressed the medical, oral, and behavioral concerns of 40,000 patients, says York.

“Many of those [calls] were just seeking lifelines, whether they were communication lifelines, or health lifelines, [patients] needed to stay connected,” he said. “We know that COVID-19 has devastated communities of color, and it has put those patients and their lives in general in the spotlight, showing how fragile they are and how much work we still have to do with the population.”

Shmuels has seen good traction in Miami with a strong transition to telehealth for behavioral providers, who were able to maintain visit volume more quickly than other specialties. As the pandemic continues, Borinquen has noted an increase in depression diagnoses due to the stay-at-home order. That’s troubling because a patient’s mental health condition “doesn't allow them to really function and be able to properly manage their diabetes, their hypertension,” Borinquen noted. He did note, however, that “we're seeing more patients following up on their mental health appointments than are even seeing their primary care physicians. They feel that they're going to get something out of it for their state of mind.”

Social media enables engagement — and re-engagement 

For each FQHC, social media has influenced ongoing strategies that are sure to impact healthcare and each organization’s future outreach and education as the pandemic stretches on. They were all able to communicate visit-safety protocols, stay-well tips, and available services quickly by compounding the use of athenaCommunicator with platforms like Instagram and Facebook Live. At Borinquen, outreach and education for AIDS patients that normally would be performed at clubs was transitioned to social media campaigns. 

Union used Facebook Live feeds frequently. “We used it weekly for patient engagement, for education, for things that are not only related directly to healthcare, but to keep patients feeling connected with providers, for giving them just health and wellness tips for talking about, even some items that might distract, some entertainment items,” explained York. “The volume and the variety of communications with patients really helped keep that bridge going.”

He sees these methods as helping inspire re-engagement, and inform about important organizational updates as patients are willing to come back for in-person services. York is hopeful about these options that have come to the front burner recently. “We need to think about our future of working greater efforts on health literacy and health education — those are key to changing the future,” he said. “When patients come to an FQHC, they receive not only care, but health education. We need to help them with their health literacy, something that is underreported around the country right now.”

Enjoy more insights from athenahealth's FQHC panelists by accessing Healthcare's Next Act content here.