Remote Care: Helping Families with Telehealth

Just a few months ago, a trip to the doctor was a normal event. But in COVID-19 times, that same visit can bring on a case of anxiety. What if you still need to take care of your family's health issues, but don't want to go to the doctor?

Telehealth has been in use for over two decades, but infrequently used. People still preferred scheduling an appointment, taking the kids out of school, and driving through traffic to meet face-to-face with their doctor. In today's world, people across the country are turning to telehealth to get medical attention for themselves and their children. Apps like TeleDoc and MDLive have existed for several years and now individual mental health providers and healthcare systems have their own telehealth services.

Telehealth also encompasses more than the kitchen-table-to-doctor's-office visit. It also includes clinic-to-school, ER-to-inpatient floor within a hospital, and consultations with multiple providers during a single call. These calls include medical appointments, chronic care protocols, behavioral health, and substance abuse support for any age.

The Impact of COVID-19 on Telehealth

The federal government moved quickly to encourage the use of telehealth services during the COVID-19 outbreak. HIPAA compliance had been an issue in the past, previously requiring providers to have a privacy compliant platform to serve clients. In March 2020, the HHS Office for Civil Rights (OCR) declared that HIPAA-covered health care providers could provide telehealth services in good faith to patients using FaceTime, Facebook Messenger, Google Hangouts, Zoom, and Skype, even if the application was not fully HIPAA-compliant. This order excluded public-facing platforms like Facebook Live, Twitch, and TikTok because they are not private platforms.

CMS and the Children's Health Insurance Program (CHIP) issued temporary measures to increase accessibility to care using telehealth services. It allowed providers to practice remote care, even across state lines, where necessary. The agency released restrictions that care could be conducted in patients' homes and outside of remote areas and deliver care to existing and new patients. Providers could also bill for telehealth services the same as in-person services.

These measures opened the door for telehealth to be used on a wider scale by both providers and patients. Prior to COVID-19, only 8% of Americans used telehealth. Other than patients in rural areas, most people considered it normal to sit in a physician's waiting room, even in the midst of flu season. The pandemic has forced people to do everything remotely, including their providers' visits. Government regulations eased to make telemedicine more available, especially to age groups 20-44 who used it most frequently.

A study at Langone Health at NYU, conducted over six weeks from March 2nd to April 14th, 2020 revealed an increase of 683% in telehealth urgent care visits and 4,345% increase for non-urgent care visits. Telehealth has become a mainstream method of connecting with physicians and is here to stay.

Children, Teens, and Adults Interact Differently with Telehealth Providers

Working adults have become accustomed to daily Zoom calls, interacting with peers on Microsoft Teams, and workplace collaboration apps. They understand how the technology works, how to interact with other participants, and how to sit still and pay attention. These interactions have become customary for adults, but teaching children what to expect during a telehealth visit can be challenging. Setting the stage for all age groups to have a successful visit is important.

The Child's Telehealth Visit

For young children, visits need to be interactive to keep them engaged. Parents and caretakers can make sure there are quiet toys in the room that keep them busy but not too distracted. Don't expect children to stay in the video frame for long, especially autistic children who may be unable to sit still.

Providers may use more video tools, like whiteboards and screen sharing, to keep the child engaged while still speaking to the caregiver. The provider will still be looking for signs of stress, neglect, and child abuse. Whether a mental health professional or medical provider, they'll be searching for clues to help the caregiver adapt to a stay-at-home environment and keep the child physically, emotionally, and mentally healthy during stressful COVID-19 related times.

Shelter-in-place orders have had a serious and long-lasting impact on adults and children. The CDC advises parents and caretakers to look for behavior changes in children and teens that include excessive worry or sadness, unhealthy eating and sleeping habits, and difficulty with attention and concentration. Everyone is dealing with their own stressors during this time, but for children it can have a devastating impact. If you see something unusual, share it with your doctor during your telehealth visit.

The Teen's Telehealth Visit

Teens are more technically savvy than their parents and will usually understand the virtual environment of the telehealth visit. The provider is challenged to quickly develop rapport with the teen, a significant challenge whether an in-person or virtual visit. A recent report indicates that the provider may ask more questions about the teen's likes, dislikes, and lifestyle to develop a trusting relationship. Once trust is developed, it is easier to get useful information from the teenager.

Parents should consider leaving the room (and earshot) of the teen's telehealth visit, unless important information needs to be discussed. Advisors suggest letting the teen share their own story with the medical or mental health provider so they can provide unbiased information. And if you find the provider sharing a YouTube video or acting less formally with a teen, it's all about building a rapport during the call to get an accurate understanding of their health.

Telemedicine Isn't a Cure-All

The pandemic has been difficult for everyone, especially children. Experts expect child abuse cases to increase because families are sheltering together in a frustrating environment. Hotlines have actually experienced a significant lack of phone calls, which concerns child protective service agencies that cases are going unreported. Since children are not in school, their primary advocates - their teachers - are not there to notice the devastating symptoms of abuse. ER doctors are only treating the most severe abuse cases, increasing fears that telemedicine may not be able to address the overwhelming number of COVID-19 related childhood trauma cases.

But telemedicine has proved to be successful for patients and their families. Vandna Mittal is Director of Digital Health Services at Stanford's Children's Health. They have a successful childrens' telemedicine program that has addressed cases from eye diagnosis in premature infants to performing electroencephalograms for neurology.

"Virtual telehealth visits are not a blanket solution for everyone or every visit, they are instrumental in helping patients and families who require more care or live away from their specialists, without sacrificing that vital connection," said Mittal. "We are able to care for more children with chronic or serious conditions than ever before, and digital health allows more flexibility and greater access to the best care available."

What Employers Can Do to Help

Employees need to know what telemedicine benefit plans are available, sending reminders about what services are covered, important contact numbers, and apps to download, and what providers are included. If your employees have not completed their profile information on your company's telemedicine app, encourage them to fill it out now before an health event occurs. Understanding how the app works, before someone needs it, is critical to employees' health and overall program acceptance.

Woodruff Sawyer Can Help

Has your benefit plan undergone extensive changes as a result of COVID-19? Telehealth is a key component that helps keep employees healthy and costs down. If it's time to schedule a benefit review, reach out to Woodruff Sawyer. We have the insights you'll need to evaluate your plan design.