Telemedicine is increasingly becoming a mainstream offering, but long before it was a buzzword in tech circles, South Dakota-based Avera Health was applying the practice to major health episodes across the Great Plains.
Now, the health system that operates in eight states is poised to expand its eCare offerings beyond assisting in emergency and intensive care to more specialty focused areas and direct-to-consumer aspects, along with long-term care facilities and places of employment.
“Those are the things we’re thinking for the future,” Dr. Don Kosiak, regional medical information officer for Avera, told MedCity News. “Not only for Avera, but for the rest of the country. In that realm of direct-to-consumer, you’re going to see more specialty care.”
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Avera’s eCare stretches across a massive and rural region that now includes South Dakota, North Dakota, Minnesota, Iowa, Nebraska, Kansas,Wyoming and Montana. That’s a total of about 565,000 to 600,000 square miles, or “about the size of France and Germany combined,” Kosiak said.
The shift of telemedicine toward more consumer-driven elements has been well documented, but Avera’s evolution is worth noting given that it’s been a pioneer in the space, with efforts dating back to the late 90s and early aughts. And how it got to be so prevalent across such a massive area speaks to both its ability to fulfill a vital need in far-flung regions and in execution for a wide range of services, from emergency assistance to telepharmacy.
Indeed, its model is more collaborative than dominance. In order to operate successfully across the huge area, Avera has worked with multiple health systems and independent hospitals.
“It’s much more of a consortium model,” Kosiak said. “We’re in many more non-Avera hospitals than we are in our own. Of course we trip across many different health systems and hospitals. The only way this works is to have lot of sites.”
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Hospitals pay Avera a subscription fee to use its technology, similar to that of a co-op, Kosiak said.
For telemedicine as a whole, Avera “lets the emergency care be a front door to that hospital,” Kosiak added. And that in turn helps both the receiving hospital attract patients, and the patient who would otherwise have to drive perhaps hundreds of miles, beginning the coordination needed to improve outcomes.
In addition to the health benefits, telemedicine brings with it obvious savings. And to that end, Avera estimates it has seen more than 210,000 patients via eCare, saving an estimated $143 million in healthcare costs. Its network includes 86 hospitals and contracts with more than 100 facilities.
The scope of region and services is thought to be among the most comprehensive telemedicine offering in the world, according to Avera. That in and of itself is worth noting because not that many major health systems have delved so deeply into the technology, though increasingly more are jumping in and there are notable exceptions. Of late, much of the technological advances and interest has come from startups and vendors.
While that’s likely to continue, Avera’s experience offers an interesting lesson for health systems, particularly rural areas but also other health systems that may join the fray. In essence, don’t take short cuts if emergency and intensive care are involved.
Physicians working with Avera operate in much the same fashion as any ER physicians, covering multiple patients with varying degrees of severity at a time. But, importantly, physicians working in an ER aren’t forced to move back and forth between the physical ER they’re working in to the virtual visit. The physician seeing patients via telemedicine only sees telemedicine patients.
“The only job they’re doing is sitting in that chair waiting,” Kosiak said. “It’s probably the most expensive model, but it’s probably also the more effective model.
“The problem is human nature,” he added. “Whatever is in front of you is going to take your priority. Our model doesn’t have that. There are not other patients to get back to. We do get multiple calls at the same time and handle that like any other tertiary hospital. But if I do that virtually, I can cover a lot of those rooms.”
There is more flexibility in the consumer and employer models, of course. But what has shifted lately is that the demand is growing.
“The neat thing is that the consumer is now asking for it,” Kosiak said.
In response, Avera is looking to shift away from the current business-hours operation and more toward 24/7 availability for common ailments.
“We’re looking at more unique ways to provide this,” Kosiak said. “Maybe it’s kiosk-based. Perhaps there is a certain set of criteria, maybe six or eight diagnosis that can be done. Not everything can be done direct-to-consumer, but I do think you’ll be able to do some of that episodic primary care or urgent care from your phone or a kiosk.”
Several of the consumer and employer approaches are currently in pilot, he added, and more will likely be known within the next three to six months.
Longer term, one thing is certain.
“I have no doubt that the landscape in five years will be different,” he said.
