How Avera Health moved beyond DTC urgent care telehealth to launch specialty practices for women's health, school-based care and a robust retail strategy

Over the past few decades, small rural communities in America have become isolated from the healthcare revolution we see in urban settings, making access to quality care a top concern for healthcare organizations serving consumers across the country, not just in the big cities.

As a rural health system based in Sioux Falls, S.D., Avera Health has seen and experienced this shift, and — out of necessity — we've been forced to seek out innovative ways to create networks of care to reach consumers in need. We've prioritized this because we believe that no matter where our patients live, they should be able to count on Avera to deliver the highest quality expertise and technology, in order to feel better and live healthier.

Telehealth has played a pivotal role in expanding care to the rural communities we serve. Avera has built a robust business-to-business telehealth model, Avera eCARE®, which connects 400 healthcare sites across 17 states. In one month, Avera eCARE serves more than 18,000 patients and saves more than $4.7 million in healthcare costs.

And while Avera eCARE has been instrumental in connecting healthcare facilities, we recognize that consumerism has now extended to healthcare and more people want access to high quality care wherever they are located. That’s why Avera launched its direct-to-consumer telehealth service, AveraNow powered by American Well, in 2015 to provide urgent care services to consumers within our 72,000-square-mile footprint. Since our move to DTC telehealth, we have evolved from strictly urgent care to more innovative use cases meant to reduce the cost of care and improve on quality outcomes. Here are three examples of Avera DTC use cases:

eGestational diabetes: Improving quality outcomes and decreasing complications

As part of an overarching women's health telehealth initiative, Avera Health has begun to pilot an eGestational diabetes program. The prevalence of gestational diabetes has doubled in recent years, and if not well managed, can result in preterm births, avoidable C-sections, birth injuries and post-delivery hemorrhaging. To help improve quality outcomes and decrease complications of unmanaged gestational diabetes, Avera remotely monitors glucose levels of expecting moms and provides remote consultations with dietitians, nurses and diabetes educators.

Early results of this pilot suggest that we can drastically reduce post-partum post-delivery hemorrhages and birth injuries for both moms and babies. We've also been able to reduce C-section rates — down to one or two out of 30 — for patients with gestational diabetes. These preliminary results show how significant it is to work with moms day in and day out to avoid the serious risks that can be associated with gestational diabetes.

School-based care: Extending healthcare to make an impact in children's lives

There is a lot of healthcare that happens in the school setting in response to everything from concussions to asthmatic situations, and not enough resources are allocated to this venue of care. In North Dakota and South Dakota, there are 2,828 and 1,195 students per school nurse, respectively, and many of these nurses move from school to school to provide care. If something were to happen when a school nurse was not present at the school, a child may have to leave school to seek appropriate medical care.

We are also facing a large increase in significant health challenges, specifically asthma and type 2 diabetes. In fact, asthma now affects more than 5 million school-aged children and causes them to miss an average of 14 million school days each year.

To address these challenges, Avera Health has placed telehealth carts in schools to provide on-demand care for children. This advanced two-way video technology and specialized digital equipment — otoscopes, stethoscope — connects students and school staff to an experienced registered nurse within five minutes. We currently serve 6,000 K-12 students in urban and rural schools in North Dakota and South Dakota, and treat everything from injuries and illnesses, to asthma, type 2 diabetes and food allergies.

We teach school secretaries how to use the technology and equipment, including how to properly place an otoscope and stethoscope. A recent example of the success of this initiative involved a kindergarten student experiencing an acute asthmatic situation. A nurse was able to immediately assess the situation remotely and assist someone on site in giving the EpiPen to that child while the ambulance was on the way. This is just one example of how this platform has allowed Avera to make a real difference in the health of school children.

Retail strategy: Using telehealth kiosks to reach consumers where they are already located

Part of our DTC telehealth strategy includes the use of telehealth kiosks in Hy-Vee grocery stores. In evaluating our urgent care access points, we found that grocery stores presented an opportunity. The population in Sioux Falls, where Avera is headquartered, is around 178,000, and the average foot traffic in a week at a Hy-Vee location is around 300,000. Consumers go to grocery stores when they are sick — either to buy medicine or to visit the pharmacy. By placing telehealth kiosks within Hy-Vee stores, we can reach consumers where they already are. Our physicians can see patients remotely from a kiosk, write a prescription if needed, and the patient can pick that prescription up from the pharmacy in the Hy-Vee store. We are also able to perform blood tests, strep tests and flu tests within the store, making it a one-stop-shop for urgent care needs.

This has been an important access point for care, and we are using it to create strong affiliations with Avera primary care providers. Avera is an integrated health system, which includes an insurance plan. Among the insurance plan's policyholders, a third of patients have no PCP attribution. We are using our retail strategy as an entry point into our healthcare system, where we hope to evolve these urgent care encounters into primary care relationships.

These are just three of Avera's direct-to-consumer use cases for telehealth, each contributing uniquely to Avera’s overall goal of delivering high-quality, low-cost care to consumers. These use cases will continue to evolve and grow in the future, as Avera continues its quest of creating networks of care to reach consumers in need.


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