Mary's Center Turns to Trusted Telemedicine Program
Written by: Daniel Baker | Published: 6/8/21
Luck is when preparation meets opportunity.
Mary’s Center – a forward-thinking Federally Qualified Health Center [FQHC] in the Montgomery Cares network which operates 5 clinics in and around D.C. – has been a safe haven for people with chronic conditions ever since they opened their doors more than three decades ago. The clinics serve the entire community but focus on providing care to underserved, immigrant populations – primarily LatinX immigrants from Central & South America.
In the early 2010s, Mary’s Center noticed that their patients were frequent users of the emergency room for non-emergency issues tying up hospitals with patients who didn’t need that level of care. Leah Shoval, Director of Care Coordination at Mary’s Center, highlighted the crux of the problem.
“People with chronic conditions were regularly admitted to the hospital for not being consistent with their care, due to access issues – transportation, cost, work, etc...,” said Shoval.
*Mary’s Center’s Silver Spring location is part of the Primary Care Coalition’s Montgomery Cares network. From 2009-2011, to reduce the amount of avoidable emergency department visits, the Primary Care Coalition ran ED-PC Connect; a program connecting emergency department patients to more appropriate and affordable primary care options. In a span of two-and-a-half years, 20 percent of patients made at least one primary care clinic visit instead of re-using the emergency department.*
So why not bring the care to the patients? Thus, in 2015, Mary’s Center began their journey into the wide world of telehealth.
After two years of planning and collaboration, Mary’s Center began delivering care to their patients virtually in January of 2017 when they launched their Facilitated Telemedicine Program [FTM]. Actually, their behavioral health team started using Zoom in 2016 for a small subset of their patients, but we’re going to focus on the FTM for now.
In an average year, Mary’s Center sees about 60,000 patients which translates into approximately 250,000 encounters. Through the FTM, they usually serve between 1,200 – 1,500 patients a year, which means roughly 3,500 encounters via telehealth. At the moment, the FTM only operates in D.C.
The FTM is time and labor intensive; a mix of equipment and people physically visiting patients at their homes. To become a Tele-Medical Assistant [MA], one must build up an exemplary track record as a MA. Tele-MAs then undergo a rigorous training program with existing Tele-MAs before they hit the field.
In practice, the MA brings the Telemedicine Kit to the patient’s home and helps collect whatever critical information the provider needs. As far as medical equipment is concerned, the Telemedicine Kit contains specialized diagnostic, lab, and vital equipment – basically everything you’d find in one of Mary’s Center’s brick and mortar clinics. They even bring a mobile hot spot to ensure a strong connection.
As Tele-MAs run through the collection process, all the information is streamed to the provider in real time through a virtual connection. This way, the patient doesn’t need to worry about how to get to a clinic or how to navigate technical obstacles. Thje best part is that patients don’t have to sacrifice the quality of care that they’d receive from an in-person visit.
After three-plus years of experience delivering telemedicine to patients with chronic conditions Mary’s Center had a model to be proud of. Then the world changed.
Facing the prospect of losing access to all of their patients due to the COVID-19 pandemic, Mary’s Center's experience implementing a successful telehealth program meant they were poised to swiftly pivot to a primarily telehealth model.
However, while not impossible to scale, the FTM could not be replicated for all 60,000 patients. Plus, stay-at-home orders for the first three months of the pandemic made traditional FTM visits challenging. And now, Mary’s Center, along with other community health centers, needed to deliver care virtually to all of their patients across the District and Maryland unless it was clinically necessary to assess in person – such as pregnant patients, children younger than two years old, and participants with critical needs.
Since MAs were home-bound, that meant important medical equipment that collected vital data -- blood pressure, heartrate, oxygen saturations to name a few – remained out of reach for a population that badly needed all the help it could get.
The challenge: find a new system for sending equipment to patients so that they can track, monitor, and care for their conditions. Thanks to Mary Center’s wealth of experience running the FTM, much of their staff was already comfortable delivering virtual care. The solution: patients were sent durable medical equipment so that health care providers could receive telling information that they would not have gotten over the phone or video conferencing. In fact, the Primary Care Coalition helped many clinics secure funding from the Community Foundation to procure much-needed monitoring equipment.
Shoval explained, “If a provider works with a patient diagnosed with hypertension,that information [such as an actual blood pressure reading] is way better than simply asking questions.”
For patients that needed help using the equipment, Mary’s Center staff – well-versed in communicating from afar – walked them through the process.
“Because we already had the system in place, the model allowed for a much easier transition to our virtual healthcare world. Providers already knew how to talk to a patient, and knew what to ask and look for when not getting vitals and lab results,” Shoval added.
There’s nothing lucky about a well-conceived plan and an innovative organization.
Success in the Numbers As noted before, behavioral health adopted telehealth services before any other program, conducting about five percent of their encounters via Zoom before the pandemic. Post-pandemic, that number has climbed to an astonishing 98 percent.
For all other aspects of Mary’s Center, about 70 percent of patients accessed care via telemedicine during the early peak of the pandemic. As time progressed and the area went through COVID-19 waves, half of encounters for the five clinics were conducted via telemedicine.
It’s one thing to implement a telehealth model. It’s another to do so in a way where a majority of patients actually prefer telehealth – notably video visits – to in-person care. Patient satisfaction surveys from 2020 revealed that televideo visits outperform in-person visits when it comes to: Ease of Scheduling, Clinical Staff Courtesy & Helpfulness, and Overall Satisfaction. Teleaudio bested in-person visits when it came to Clinical Staff Courtesy & Helpfulness and nearly equaled in-person visits for Overall Satisfaction.
As always, Mary’s Center is looking to the future of care. Shoval and the Chief Medical Officer, Dr. Tollie B. Elliott, presented the idea of FTM Pop-Ups to the Montgomery County Council as they look to expand this service beyond the nation’s capital. “Think of it as a community site from say, 12-5 [pm], where we can see more participants closer to their homes, without them having to rely on more intensive transportation options,” said Shoval.
Mary’s Center understands that their model and knowledge are valuable to the medical community. They participated in the HHS Telemedicine Hack and are part of the Virtual Care Innovation Network to share with and learn from other clinics around the country.
When the next opportunity presents itself, you can bet that Mary’s Center will be well-positioned to meet the challenge. *The article has not been reviewed or approved by Montgomery County Department of Health and Human Services (DHHS)*