Could This Be The Key to Rural Telehealth Scalability?

A collaboration between Rochester University Medical Center and Five Star Bank is putting telehealth kiosks in bank branches, offering new insights into how to improve access to care in rural regions

The University of Rochester Medical Center is banking—literally—on a new strategy for extending its telehealth network into rural areas of New York.

In a partnership with Five Star Bank, Verizon, and digital health companies Higi Health and Dexcare, URMC is co-locating telehealth stations in Five Star branches across the western part of the state. The model aims to improve access to care for rural residents, especially those on Medicaid and Medicare, who face geographical and technological barriers.

Michael Hasselberg, PhD, URMC’s chief digital health officer, says the health system came out of the pandemic seeing measurable benefits in a telehealth platform for rural residents, but most were using a phone to access care. In order to include Medicare and Medicaid reimbursements, URMC needed to establish an audio-visual telemedicine link.

“We thought, rural communities, what do you have?” he said. “You’ve got a traffic light, you’ve got a Dollar Store, and you’ve got a bank. What about banks?”

In singling out banks, Hasselberg identified a challenge facing health systems and hospitals looking to expand their telehealth networks. Many programs have focused on putting kiosks or telehealth stations in community centers, libraries, barber shops and hair salons, malls, and other retail locations. In most cases that means working with a different party at each location.

A patient uses a URMC telehealth kiosk at a Five Star Bank in New York. Photo courtesy URMC.

Banks, however “are in these branch distribution models, so they’re scalable,” Hasselberg noted. “I can’t scale a library, or a barber shop, or a community center because I, as a health system, have to negotiate with every single [site]. But if you negotiate with a bank, you have, potentially, access to all their branches across the region.”

In addition, and just as important, the costs of launching the program are reduced.

“The organizations partnering to make this pilot a success have all offered generous, in-kind support,” Hasselberg said. “Verizon Business is contributing the necessary telecommunications infrastructure. DexCare and Higi are providing leading-edge telehealth software and Smart Health Stations, respectively, to connect rural residents with UR Medicine physicians. And Five Star Bank is volunteering private space in its bank branches to create a healthcare access point for its neighbors in a familiar, trusted, community location. UR Medicine is not funding the Five Star Bank space.”

Addressing Key Gaps in Care Delivery

The program, which is currently in three branches, gives consumers and patients an opportunity to track key biometric markers, such as blood pressure, obesity, and blood sugar, through connected devices and an app managed by Higi. Through DexCare, visitors can connect for a virtual visit with a physician in the health system for treatment or to schedule an in-person visit.

“We already had an on-demand telemedicine service line that is staffed by our primary care doctors,” Hasselberg noted, “So we just kind of built off of that.”

The program addresses a number of care gaps that health systems face in serving rural regions. According to Hasselberg, roughly three-quarters of the health system’s rural patients live at least 10 miles from the nearest brick-and-mortar care site, but more than half live within three miles of a Five Star bank.

And studies have shown that consumers are often reluctant to visit a doctor’s office or clinic for a minor or nagging health concern unless or until they really need urgent medical care, often postponing care and running the risk of developing a more urgent health issue later. Co-locating a telehealth station in a bank, often located near other community services, gives the consumer an opportunity to combine a few errands in one trip, or to consider a virtual visit while out running other errands.

In a unique example, Hasselberg noted that one of the telehealth kiosks is located in a community with a sizable Amish and Mennonite population (the bank even has a drive-through for customers using a horse and buggy). Providing easy, convenient healthcare access for a population that traditionally keeps to itself and eschews most technology at home could go a long way toward improving care and outcomes for that group of people.

Unique Benefits to Telehealth

Hasselberg noted that many rural residents, particularly those with limited incomes, have higher rates of no-shows, cancellations, and ED visits and tend to skip or avoid filling prescriptions. All of those issues, he said, were improved significantly through the use of telehealth during the pandemic. And many don’t have or can’t afford broadband services in their homes, which a telehealth kiosk addresses.

The platform also gives URMC a visible presence in rural regions where brick-and-mortar sites are few and far between, at a time when disruptors like Walmart, Walgreens, Google and Apple are looking to stake a claim in the busy primary care space.

“What we have found is healthcare is local, especially in these small, rural communities,” Hasselberg said, adding the disruptors are doing more to improve healthcare than create competition. “Having a trusted health system to deliver care, and that understands these communities … is really, really important.”

“Our [goal] wasn’t to make money,” he added. “We needed to create access…. We’re not going to be looking at this through the lens of, are we generating enough volume to make a profit?”

Tackling Social Determinants of Health

In addition, co-locating a telehealth station in a bank gives URMC an opportunity to address several  social determinants of health.

“Financial health is so closely tied to physical health,” noted Hasselberg, who said a patient could be referred to the bank right after the telehealth visit for help understanding, planning for, and paying medical bills. “We might be able to affect healthcare access and financial instability at the same time.”

Hasselberg sees plenty of opportunities to expand the program, not only to other bank branches and potentially other banks, but to assisted living and skilled care facilities, which struggle to connect their patients to the care they need. In addition, he sees more services being available through the kiosks, including chronic care management and follow-up care. They could even be used as access points for resident sot connect with local primary care physicians.

“We all went into this going, ’This may be a nothing-burger,’” he said. “And patients [may] go, ‘I don’t know about getting healthcare in a bank.’ But what if it does work? That’s the really exciting part. Because if this does work, it could be transformative. It could be replicated across other health systems and across other banks across the country.”