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Factors Behind the Adoption of School-based Telehealth

Schools are taking innovative approaches to telehealth. But can a system that's always struggling for funding find a path to sustainability?

Source: Thinkstock

Telehealth is changing how schools deliver healthcare services for both students and staff.

Gone are the days when the school nurse would sit in a tiny room near the principal’s office, administering Band-Aids and aspirin and babysitting sick children until a parent could drop by to pick them up.

Today’s school districts don’t have the funding to put a nurse in every school, and those who do exist are often overwhelmed by a variety of issues, from complex emotional and behavioral health cases to children with one or more chronic conditions.

“School-based telehealth involves the use of telecommunications, including interactive video conferencing and store-and-forward transmissions, to deliver a variety of healthcare services to children located in a school,” the American Telemedicine Association said in a report titled State Medicaid Best Practice School-Based Telehealth.

“School-based telehealth is a delivery method that can be used to improve health quality and academic outcomes,” the report continues, “and provide access to a wide spectrum of care including primary and acute care, chronic disease management, behavioral and mental health, speech therapy, dental screenings, nutritional counseling, and prevention and health education.”

For little more than a decade, schools have been looking to technology to solve patient access to care issues for their student body. A desktop PC or laptop with a video link can connect small and rural schools with a nurse at the district’s head office, or even to a doctor at a nearby hospital. A telehealth platform can also be used for behavioral health counseling, hearing and speech therapy, and even eye, hearing, and dental exams.

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STATE-LEVEL APPROACH TO SCHOOL-BASED TELEHEALTH

While school districts and health systems have created telehealth partnerships for several years, Texas, Georgia and New Mexico were the first states to mandate Medicaid reimbursement. Texas enacted a law on Sept. 1, 2015 that enabled physicians to set up a video-based telehealth platform to meet with students as long as the student is at school and enrolled in the state’s Medicaid program for the poor and disabled.

“Ninety percent of what you would see in a general pediatric clinic, we can handle it by telemedicine,” Richard Lampe, Chairman of the Department of Pediatrics at the Texas Tech University Health Science Center — which has run a school telehealth program for more than a decade — told the Texas Tribune when the law went into effect.

In South Carolina, the Medical University of South Carolina launched its school telehealth project by identifying schools in the state’s poorest regions, where kids with any health issue went straight to the hospital ER. Shawn Valeta, MUSC’s director of telehealth, said the program has reduced the burden on ERs while boosting morale health outcomes in the schools. The program began in three schools, expanded to 20 and is expected to reach 40 schools soon.

The Georgia Partnership for Telehealth, one of the nation’s top regional resource centers, maintains a telehealth platform for more than 100 schools in Georgia, Florida and Alabama, including a few colleges. Rena Brewer, the GPT’s chief executive officer, says school districts and health systems have to look past the technology and focus on the partnership.

“Technology can be very intimidating, and many people make the mistake of thinking that’s where you have to start,” she says. “Some hospitals just can’t get past that initial loss of revenue, so they lose interest or fail to push back. … They don’t realize that you don’t have to buy the Cadillac — you look at what you have and what your community really needs the most, you manage expectations and you create relationships.”

School districts are taking different approaches to telehealth, often because they don’t have the financing or resources to take on the project themselves. The renowned Nemours Children’s Health System, with hospitals in Delaware, Florida, New Jersey and Pennsylvania, recently launched its first school-based telehealth platform in Florida, serving a Miami-based special needs school.

“Ninety percent of what you would see in a general pediatric clinic, we can handle it by telemedicine."

Dr. Shayan Vyas, medical director of telehealth for Nemours, says the health system is looking for any and every partnership it can find to bolster the platform and make its cost-effective and sustainable for schools.

“There’s not one district in Florida that has a nurse in every school,” Vyas, a father and passionate advocate for school-based telehealth, notes wryly. “And we have not experienced a wealthy school district.”

On the opposite side of the country, the Los Angeles Unified School District — the nation’s second-largest district, with more than 1,000 schools and 650,000 students — recently placed telemedicine carts in five schools. The carts, which cost $25,000 to $60,000, are fully subsidized by LifeMD, a Florida-based telemedicine provider.

“There’s incredible interest in schools” for telehealth, says company spokesman Tim Bruce, “but they often have their budgets mapped out years in advance…This gives them the chance to focus on what is important.”

Bruce says the company will bill the insurer or health plan for each student visit and cover the costs for uninsured students — a bold move, as 20 percent of the school district’s students don’t have insurance. The hope is that once the platform shows value in reduced absenteeism, improved student health and better test results, the district can budget a telehealth program for all of its schools, possibly by qualifying for reimbursements or grants.

In Missouri, school districts are looking at the state’s newly enacted telehealth law, which enables them to bill the state’s Medicaid program, MO HealthNet, for video visits. That law could enable cash-strapped schools — and there probably isn’t a school administrator out there who would describe his district in any other way — to fold federal mandated special needs programs into the mix.

This could be “the greatest thing in the world” for school districts struggling to pay for the federally mandated services and find qualified specialists, says Phyllis Wolfram, president-elect for the Council of Administrators of Special Education and executive director of special programs for the Springfield, Missouri Public School District.

“There is a shortage of speech language pathologists across the nation, and Missouri is no exception to that rule,” she said. “When we have a difficult time finding speech language therapists, we will be able to use this service as well as continue to bill Medicaid.”

In Cassville, Mo., the Cassville School District wanted full support from teachers and staff before launching a telehealth platform for students. So the district created a platform first for its employees.

"What the school board and I intended to do with this service is provide another embedded benefit to our employees, and at no cost," Superintendent Richard Asbill said. "It makes it a powerful part of our benefits structure.”

“Employees who have easy access to healthcare are more responsive to employment needs,” he added.  “In school business, our employees are exposed to a variety of germs and contagious items. So, by providing a [telehealth] access option to our employees, they are better able to care for themselves or their own family members."

With the program proving such a success, the district is now prepared to expand the platform to students.

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TELEHEALTH GOES TO COLLEGE

Colleges and universities are also taking to telehealth, though the challenges there are different. With a more adult population — and one that’s far more mobile — schools have to develop telehealth services that go to the student. Some mHealth companies specializing in house calls are targeting their services to college students, offering dorm visits for those too busy to visit the health center.

Colorado State University in Fort Collins has launched a student portal — accessible on mobile devices — that connects students to crisis and behavioral health resources both on-campus and online. The 33,000-student school saw a need after losing eight students to suicide in two semesters.

“Students are dealing with a myriad of issues, and often they don’t even think about it in terms of mental health,” says Joe Conrad, a CSU alumnus and founder of Grit Digital Health, which partnered with CSU to launch the YOU@CSU portal. “What we wanted was a solution that really met students where they are … and allowed them to find what they need.”

“They’re accustomed to having mobile devices,” says Conrad. “This is anonymous, it’s available to them 24/7, and it’s something they can access very quickly in a safe and secure location.”

More recently, colleges and school districts have been turning to mHealth and telehealth to deal with injuries on the sports field – especially concussions, which can be difficult to detect without an analysis by a neurologist or some similar specialist. And at the high school level, schools barely have the money for an athletic trainer, let alone the technology to test students on the sidelines.

Here's where partnerships are extremely helpful. One developer of an mHealth device designed to test athletes for a possible concussion, Pittsburgh-based imPACT Applications, is now working with NFL teams and health systems in San Francisco and Houston to put its technology in the hands of school districts. The company is also working with the Dave Duerson Athletic Safety Fund to make the technology available to underserved and rural schools across the country.

“Replacing an office visit with a telemedicine visit can allow the student-athlete (to) begin the correct treatment plan sooner and safely return to school and sports faster,” Greg Grissom, vice president of corporate development for the Houston Texans, which is partnering with imPACT and Houston Methodist Hospital, said. “Many student-athletes in southeast Texas are two to three hours from a concussion specialist, so this telemedicine program gives Houston Methodist a chance to provide the same level of concussion care as our players receive.”

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