🔒Telehealth gains traction in CT, but hurdles remain

In the days following an opioid overdose, making sure a patient sticks with withdrawal-symptoms medication can help prevent a relapse.

To ensure that happens, or at least increase the likelihood, Hartford HealthCare’s Rushford Center recently started using follow-up video calls with overdose patients to assess them and prescribe a refill, if necessary, as soon as possible.

“It’s really crucial to catch someone while they’re ready,” said Dr. J. Craig Allen, medical director of Rushford, which provides inpatient and outpatient addiction and mental health treatment.

While Rushford’s virtual-visit volume remains small for now, Allen said he sees potential for ramping it up soon, with a particular eye toward eastern Connecticut, where the care provider has fewer physicians to see patients.

“This is one of the waves of the future, absolutely,” he said.

Spurred by more favorable state laws, Connecticut’s healthcare industry, ranging from hospitals and urgent-care clinics to physician practices and community health centers, is increasingly using and experimenting with virtual doctor-patient visits and consults between fellow health providers. Insurance coverage for so-called telehealth services has also become more common, since state lawmakers in 2015 demanded parity between in-person and virtual healthcare services.

Commercial insurance claims for telehealth services in Connecticut grew 91 percent between 2014 and 2018, according to Fair Health, a New York-based nonprofit that collects and analyzes health insurance claims.

However, that pales in comparison to the rest of the country, which averaged 626 percent growth in telehealth claims over that period.

As of 2018, telehealth services — though a very small portion of overall health claims — were nearly five times as common nationally than they were in Connecticut, comprising 0.14 percent of total claims in the U.S., compared to Connecticut’s 0.03 percent.

Competition heats up in urgent care

One of the healthcare niches locally that’s been particularly active in adopting telehealth services is urgent-care facilities.

Last month, pharmacy giant CVS Health, which already has been competing with urgent-care providers with its in-store MinuteClinics, announced its employed and contracted providers will start providing virtual visits for Connecticut patients through the CVS Pharmacy mobile app.

Meanwhile, CVS competitor Walgreens is already offering telehealth services in Connecticut through arrangements between MDLIVE and DermatologistOnCall, and Rite Aid is working with a company called InTouch Health to roll out in-store telehealth kiosks, though the company hasn’t said when kiosks might appear here.

Meantime, GoHealth Urgent Care’s nearly 20 Connecticut locations, which are a joint venture with Hartford HealthCare, began offering virtual visits nearly a year ago.

“It’s a matter of getting in [the market], getting your name out there and doing it well,” said Dr. Jason Kurtzman, who sees patients both virtually and in person for GoHealth Urgent Care.

Different providers will have varying comfort levels with seeing patients via video screen, Kurtzman said, but he has found there are plenty of conditions he can confidently diagnose virtually, including mild allergic reactions, coughs, rashes, and in some cases even urinary tract infections and determining whether a laceration needs stitches.

“As more people become aware of this, it’s only going to grow,” he said. “It’s a huge opportunity for business development.”

“It’s going to eat into the volumes seen at urgent cares, emergency rooms and primary care offices,” he added.

Not all urgent-care providers, however, are sold on telehealth, including Dr. Michael Gutman, medical director of New England Urgent Care, which has four locations in Greater Hartford.

For many conditions presented at his urgent-care facilities, he said he isn’t comfortable diagnosing them virtually.

“I’ve toyed with the idea myself of putting telehealth as part of our offering, but I decided not to because telehealth is such a limited tool,” said Gutman.

He’s also skeptical that investing in a telehealth platform would increase revenue. He said that’s part of the sales pitch he hears from technology providers, and he also suspects that some urgent-care facilities using telehealth are hoping it will be a referral vehicle for in-person, potentially more expensive visits.

Medicaid movement

Rushford’s fledgling telehealth offering is among more than a half-dozen ongoing or upcoming virtual-care efforts within Hartford HealthCare.

The health system also provides telehealth services for stroke evaluations, wound care, urgent care, follow-up monitoring of pacemaker incisions and lactation consulting.

Chris Peterson, Hartford HealthCare’s director of telehealth and virtual health, said there is plenty of opportunity to scale up.

“We need to find a way to open the floodgates,” Peterson said.

One particular hurdle to doing that, at least for now, is the state’s Medicaid program.

While it covers some electronic consults between primary care doctors and specialists, the highest-volume type of telehealth — patient-to-provider care — is not covered.

“Absolutely it’s a hindrance that Medicaid doesn’t cover telehealth,” Peterson said. “Medicaid patients have a lot of health needs and can have a hard time getting to appointments. It’s really critical.”

But the situation could be changing.

At the nudging of state lawmakers, the Department of Social Services, overseer of the state’s Medicaid program, is working on a proposal to cover patient-provider telehealth services. It wasn’t clear as of press time exactly which types of telehealth services would be covered, or how long it would take to implement.