In California’s wine country, a group of safety-net clinics quickly shifted their operations in response to the pandemic. Members of the Redwood Community Health Coalition rearranged waiting rooms, begin screening all their patients for Covid-19 symptoms, and set up telehealth visits.
“I think people don’t realize how big a change it was for the healthcare system to have to think through every little aspect of what they do,” said Dr. Karen Milman, CEO of the Redwood Community Health Coalition. “Now, everyone who comes into the clinic has to have a phone or a video conversation before they even come to screen them to see if they have symptoms.”
Before the pandemic, many community health centers didn’t have telehealth systems in place. A recent review of federal data by Health Affairs showed that of 1,330 community health centers, 56% of them did not use telehealth at all in 2018. They cited reimbursement and lack of funding for equipment as their biggest obstacles.
Fortunately, the Redwood Community Health Coalition had already begun to build out its telehealth services.
“We had already been looking at that because we are in a mixed rural-urban area. We had identified a need to expand remote care before the pandemic,” Milman said. “We pretty quickly in our health center switched over. At one point, almost 60% to 70% of patient visits were remote.”
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Planning around connectivity
At West County Health Centers, which cares for patients in western Sonoma County, some patients would have to travel more than an hour for their appointments. The nonprofit had used telehealth before, but some patients didn’t have good enough broadband service for video appointments. With the Covid-19 emergency, physicians were able to call their patients.
“The connectivity is quite poor, but the phone service is really good,” West County Health Centers Medical Director Dr. Jason Cunningham said. “No-show rates are down. For patients who struggle with transportation, that’s been a huge win.”
Most of these tech deployments are typically funded over time through innovation grants. But with Covid-19, it’s been different.
“This is where I’m saying, let’s spend money on this because if we don’t, I can’t get paid. It has to be part of our survival,” Cunningham said. “It’s been a different cadence of implementation now.”
They’ve also created their own tools. West County Health Centers repurposed a mapping tool it developed to keep track of patients that were affected by the wildfires that swept through Northern California last year. Cunningham said they were now using it for homeless outreach, with surveyors asking if they need water, food, or other supplies, and if they’ve experienced any Covid-19 symptoms. It also would let them identify potential Covid-19 hotspots.
Through a grant from the California Health Care Foundation Innovation Fund, primary care physicians working at Redwood County Health Coalition clinics will be able conduct e-consults with specialists through startup RubiconMD’s platform. It will allow them to meet virtually with specialists for oncology, dermatology, neurology, and now for Covid-19 cases.
An outsized role
Beyond providing care for their patients, community health centers have a big role to play in helping facilitate Covid-19 testing and supporting their communities through the broader effects of the pandemic.
For example, they’ve been watching to see if patients need housing, food or mental health services.
“We’re already in an area of the country where it’s very expensive to live here. People who were just getting by before are really struggling to make ends meet,” Milman said. “You now have a large group of people who have been hit economically, and they may have lost their health insurance. How do you get new patients into care?”
So far, Milman said the top two needs they see among patients are rental assistance and food support. They’ve been developing ways to distribute food and refer patients out to community organizations that can support them outside of the health system.
“I don’t think people always have an awareness of how much community health centers do,” Milman said. “We’re doing cutting edge work and trying new technologies.”
Photo credit: exdez, Getty Images
