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In rural Midwest, a telehealth community thrives

Jody Clements was bowling with his kids—and rather poorly, he recalls—when he felt sudden pain in his left arm and noticed it was “quite warm and quite swollen.”

“I’ve had some medical training,” says Clements, the 47-year-old deputy chief of the Marshfield (Wisconsin) Fire and Rescue Department. “So, I’m like ‘Yeah, that’s an infection and it’s not going away.’”

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His diagnosis was confirmed by a physician at an urgent care center and it was classified as cellulitis that required inpatient intravenous antibiotic treatment.

But then Clements was presented with another option, the Home Recovery Care program the Marshfield Clinic Health System operates with Nashville-based Contessa Health.

For Clements, a single dad looking after a 13-year-old son and 11-year-old daughter, the choice was easy. Being treated at home allowed him to keep cooking supper for his kids and it kept him out of the hospital.

The Home Recovery program involves home visits by a nurse, communication with a doctor via a computer tablet, answering a daily questionnaire, and supplying daily readings of weight, blood pressure and temperature over a 30-day period.

Marshfield launched Home Recovery Care in September 2016 and about 13 patients used the service that year. That number grew to 250 patients in 2018.

Home Recovery Care started with providing in-home acute-care services for six medical conditions, and that list grew to more than 150 conditions. Quality measurements have been impressive with readmissions down 41 percent and patient satisfaction up 22 percent.

What Clements liked was that he didn’t experience the typical sleep deprivation that occurs in a busy hospital. He also thinks there were fewer things competing for his physician’s and nurses’ attention.

“I think I reacted to the antibiotics and everything better and quicker for the mere fact I was able to sleep,” he says. “And the doctor and nurse interactions were wonderful. I felt like there were no distractions and I was the focus of everything they had to do.”

Remote locations led to remote care

The Home Recovery program is one of the latest uses of telemedicine technology utilized by the Marshfield system. A pioneer in this field, Marshfield began using telemedicine for radiology in 1997 with help from grants from the federal Office of Rural Health Policy and Office for the Advancement of Telehealth. Most health systems were not actively using telemedicine until a decade later.

Marshfield has also been a pioneer in getting reimbursed for telemedicine services, and was the first health care organization in Wisconsin whose telemedicine program was approved for Medicaid reimbursement, according to a Commonwealth Fund case study on Marshfield published in 2009.

“Marshfield Clinic has been a leader in promoting the adoption of telehealth and in developing related business strategies and financial models to make the service viable,” the report said. It was also noted that Marshfield’s telemedicine program reflects “a successful focus on the human relationship in a technologically enhanced patient encounter.”

Marshfield Clinic Executive Director and Chief Clinical Strategy Officer Narayana Murali, MD, agrees with that assessment.

Marshfield’s service area includes about 1.1 million patients spread across a 30,000-square-mile area. Its 60 locations are mostly located in small towns of 5,000 or fewer people.

“It becomes very difficult to cover that range and have a provider available at all sites at all times,” Dr. Murali said. “It’s prohibitively expensive.”

Read this story in its entirety as featured in our inaugural issue of AMA Moving Medicine.