KC CARE Health Center is a federally qualified health center in Kansas City, Missouri. It is one of a handful of such medical clinics in the greater KC region. The center serves patients with limited access to healthcare. About 40% of their patients have no insurance, and about 30% have medicaid or medicare as their primary insurance.
KC CARE serves as an expanded primary care facility. Along with the normal practices of a primary care facility, though, KC CARE is also the largest primary care practice in the region for people living with HIV. The center works with other community health organizations and medical practices and hospitals. They conduct public health outreach and walk-in testing for people living with HIV. Additionally, they are well equipped to coordinate with other health professionals for individuals with special and challenging healthcare needs.
In June, KC CARE became an FCC Telehealth Grant recipient for their rapid telehealth response to the COVID-19 pandemic in the KC community. When COVID-19 hit, face-to-face primary care appointments became difficult and risky. This volume of visits to KC CARE almost entirely shut down, and the clinic’s primary care and behavioral health volume was cut in half. Within a few days after the national emergency was declared, KC CARE leadership decided this care gap needed to be filled. To do this, they increased their telehealth services in primary care and behavioral health.
KC CARE had already forayed into telemedicine pre-COVID. Through their partnerships and contracts with individuals in staffed living environments, they had some capacity to work remotely with patient populations like care homes, the criminal justice system and the foster system. This baseline structure allowed KC CARE to scale up their telemedicine capacity relatively quickly.
To do this efficiently, and to maintain HIPAA-compliance, KC CARE needed expanded software and hardware capacity around telemedicine. Needed updates included appointment scheduling and visit systems, old machinery that would now be used more often, and potential technology for regular patients without internet access in their homes. Various funding mechanisms were available through federal government stimulus packages, including the FCC Grant that KC CARE was eventually awarded.
Using the extra resources, KC CARE has shifted its software platform to increase its security and at-home patient usability. For example, the new software allows patients to join an appointment with a single click. There is no requirement to download an app or create an account, increasing accessibility for patient populations without high technological literacy and/or access.
KC CARE’s ability to quickly adapt and secure capacity-building funding is definitely beneficial, as it seems that telemedicine is here to stay for the foreseeable future. By April, KC CARE was performing about 45% of their patient visits remotely. Some physical appointments have now returned, but it seems that about 20-20% will continue via telemedicine indefinitely. Through this reopening process, KC CARE has been able to identify those appointments that can almost always be done remotely. For example, behavioral and medical prescription evaluations can often be done without a physical check-up.
Since receiving the FCC grant, KC CARE leadership is exploring potential further funding for further technology to make their expanded telemedicine services more accessible, for example smart phones for people who do not already have devices of their own. Adding connectivity into households and living situations to support those who are better served at home is also being explored. This is an area in which partnerships with community health workers can be built upon for success. For example, the clinic is working with the school district to potentially set up televisits between a KC CARE clinician on one end and a student and school nurse on the other. Another area where telemedicine may be helpfully expanded is KC CARE’s young clientele, already tech-enabled, who may be served by PrEP via telehealth opportunities.
There are some services that will continue to necessitate in-person healthcare visits. This is especially the case for young children. For example, getting parents to bring young children into the clinic for vaccines can already be difficult to arrange. Another example is child well checks, for which a physical examination is important. If a televisit ends up needing to be converted to a face-to-face visit, KC CARE has decided to treat the appointments as a single visit in order to not double the patient’s copay.
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