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Drake takes on telehealth initiative to improve healthcare access for rural Iowans

Drake University is partnering with telehealth company Certintell and medical technology company Tabula Rasa to provide telehealth services to Iowans in rural areas. Their goal is to improve health outcomes for at least 1,500 currently underserved patients over the course of 5 years.

“Without telehealth, patients just aren’t going to get the services that they need, and telehealth has shown to be effective,” said Certintell CEO and founder Ben Lefever, who graduated from the Drake School of Journalism and Mass Communication in 2000. “It’s shown to really improve health outcomes and essentially save lives and keep patients out of the hospital and have better quality of life.”

The initiative is made possible by a $1.6 million grant from the federal Health Resources and Services Administration. Drake brought together the necessary companies and resources for the initiative and plans to keep track of patient data as the project progresses, according to Grant Awes, the manager of the Certintell side of the HRSA initiative. 

Improving health outcomes by making care more regular

Awes, Lefever and Tim Welty, the principal investigator for the initiative, described the initiative’s two main components. The first involves medication therapy management and medication risk assessments, in which a physician reviews potential interactions between a patient’s medications to determine if the combination is both safe and effective. 

These services will be provided through the MedWise call center, an arm of Tabula Rasa, Welty said. The call center employs approximately 20 to 30 Drake pharmacy students each year, who are supervised by a Drake-hired pharmacist.

“The call center will be looking at patients who are in the grant and looking at all of their medications and determining a risk factor based on medication safety,” Welty said.

Welty also said that this is the only initiative funded by HRSA to include medication management. This is significant because Medicare patients are required to undergo a medication review once a year, so the call center will lighten the load on local clinics whose services are often stretched thin in rural areas.

The second component involves regular telehealth appointments with coaches and physicians through Certintell. Although the telehealth visits are not designed to replace patients’ family physicians, they can provide in-between check-ups with rural patients who do not have easy access to a physician’s office or hospital.

“We [Drake] have the call center aspect of it. [The call center] will be working with the patients in terms of medications,” Welty said. “Then there’s the telehealth aspect, where there will be a nurse, nurse practitioner, or telehealth coach who regularly connects with the patient via telehealth, and then the Certintell people will be in contact with their primary care provider.”

In order to connect more regularly with patients, the telehealth appointments are supplemented by Remote Patient Monitoring, Lefever said. This involves sending Bluetooth-connected equipment, such as a blood pressure cuff or glucose monitor, to patients so that the telehealth platform can receive more real-time data. 

The equipment is designed to work with a phone so that rural Iowans with poor or nonexistent broadband service can still participate in the initiative—a significant issue in a state ranked 36th in the nation for broadband access, according to BroadbandNow.

“Let’s say someone in rural Iowa has a heart condition or heart disease and they need to be monitored regularly,” Awes said. “We are able to ship them a blood pressure cuff that is cellular based, so they can take a reading by themselves from their home. And that cellular device will send it just like a cell phone sends a signal, so that [data] will come to us.”

Rural Iowans face healthcare access challenges

Palo Alto County and Hancock County, two primarily rural counties in North Iowa, are the current area of focus for the initiative. Each county has a MercyOne critical access hospital. According to Welty and Lefever, Iowans in these areas are unlikely to have easy access to regular healthcare services, especially specialists.

“Many of them will live long distances from hospitals,” Welty said. “They may live in communities where there’s not a physician regularly. Some of these communities don’t even have a pharmacy in them, so access to care is a big problem.”

Welty said that the areas served by the initiative could expand in future years, and Awes added that the goal is to serve one additional rural MercyOne clinic each year.

Another component of the initiative that may expand is the breadth of the conditions addressed. Currently, the initiative focuses on the treatment of hypertension, diabetes and high cholesterol because, according to Welty, these are the conditions that most often result in emergency hospital visits. Besides relieving the medical strain on local physicians, decreasing such emergency room visits is one of the main goals of the initiative. 

Prior to the pandemic, few insurance companies reimbursed patients for telehealth services, Lefever and Awes said. However, Medicare and Medicaid are now reimbursing telehealth services at the same rate as an in-person visit. This has accelerated Certintell’s business, as well as the telehealth industry as a whole.

“One lesson for the health care system from COVID is telehealth,” Welty said. “When COVID hit and hospitals and clinics closed down, they pivoted to telehealth.”

Due to the pandemic-induced shift in insurance coverage, Levefer, Awes, and Welty all said they expect telehealth services to become more commonplace in general healthcare. Lefever said that 80 percent of all healthcare services can be provided via telehealth and do not require an in-person visit.

“I expect telehealth to be standard practice,” Lefever said. “It’s just going to be part of how your primary care providers or whoever you see are going to deliver services.”

The project described is supported by grant number 1 G01RH42535‐01‐00 from the Office for the Advancement of Telehealth, Health Resources and Services Administration, DHHS.

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