The state is one of the first to fully sanction veterinary telemedicine, a growing trend since the pandemic that has shown to benefit not only the pet but the pet's owners.

Arizona Governor Katie Hobbs has signed legislation allowing residents to use telemedicine to access care for their pets.

SB 1053, which drew almost unanimous support from both the Senate and the House, was supported by a strong coalition of animal rights groups, veterinarians, and farming advocates. Among other things, the bill amends current law to allow pet owners and veterinarians to create a relationship via virtual care rather than first meeting in person.

While the industry is overseen by the American Veterinary Medical Association, state veterinary medicine boards are responsible for establishing telehealth guidelines and rules. The most common uses are for initial diagnoses, to determine whether the pet needs to be brought into the office, for consults with specialists such as radiologists, and for the care and treatment of farm animals and livestock.

Most states require that a veterinarian-client patient relationship (VCPR) be established in a face-to-face meeting before moving to telehealth, with the exception of an emergency. And many states and the AVMA oppose the use of telemedicine for remote consulting offered directly to the public in the absence of a VCPR – in other words, direct-to-consumer telehealth for new clients.

Support for veterinary telemedicine soared during the pandemic, when pet owners sought a means of getting care for their pets without visiting a veterinarian. Some 19 states, including Arizona, passed legislation to enable veterinarians to conduct virtual visits during the COVID-19 crisis, and Arizona is one of the first to make that practice permanent.

According to the Veterinary Virtual Care Association, only Idaho, Virginia, and New Jersey allow virtual care for pets without restrictions, while roughly 33 states require either an in-person exam or some sort of prior relationship before switching to telemedicine. Only New York bans any use of telemedicine for veterinary care.

Arizona's approval of a veterinary telemedicine bill drew support from the Goldwater Institute, a conservative and libertarian think tank based in Phoenix.

"A chronic shortage of veterinarians has created veterinary deserts throughout the United States," Mark Cushing, founder and CEO of the Animal Policy Group, wrote earlier this month on the organization's website. "Pet owners of all ages don’t hesitate to seek veterinary advice and care, but such care is often available only through digital tools. Veterinary trade associations resist these changes, ignoring the key principle that telemedicine requires an informed choice by the veterinarian and pet owner to proceed without an in-person examination of the pet."

While aiming to improve access to care and clinical outcomes for pets, veterinary telemedicine is also showing up on the radar for health plans, self-insured businesses, and private payers, who see pet care as an important part of member engagement and satisfaction. Pets are also being considered a social determinant of health, with research showing that pet ownership has a positive impact on the owner's health.

Pet care companies like Chewy and Petco Health have been expanding into telemedicine service, with the latter estimating the value of the service at $119 billion in 2021. And just last month, Walmart signed a deal with pet telehealth company Pawp to offer its members access to veterinary services via video or text without an appointment.

A partnership between the University of Texas and telehealth provider MDLIVE will give roughly 11,200 students between 10 and 18 on-demand access to psychiatricts or therapists through a telehealth platform at school, an mHealth app, or a phone call.

Close to a dozen school districts in Texas will have access to virtual behavioral health services for their students through a partnership between the University of Texas and telehealth company MDLIVE.

The new program will offer some 11,200 students between the ages of 10 and 18 on-demand virtual access to MDLIVE licensed psychiatrists or therapists, either from a dedicated telehealth platform at the school or through an mHealth app or phone call. Students can also request a provider that aligns with their gender and ethnicity.

The program seeks to address the growing behavioral health crisis in schools, with schools struggling to find the healthcare resources needed to treat students and students facing barriers to accessing those care options.

The pandemic exacerbated that crisis, making it even harder for students to get in front of care providers. According to research by MDLIVE parent company Evernorth, there has been a 14% increase in suicide-related diagnoses in children and adolescents since the start of the pandemic, accounting for 35% of all patients with these health concerns.

This program was developed by the University of Texas at Austin's Institute for Public School Initiatives (IPSI), and is supported by a US Department of Education grant.

“This initiative will help address the alarming rise in mental health issues among young people today and provide essential resources to students who would otherwise have limited access to quality mental healthcare," Matt Orem IPSI's associate director, said in a press release. "It was not only the size and quality of MDLIVE’s network of providers and suite of behavioral health services that led us to choose them as our partner, but also the flexibility of their care delivery platform to meet the unique needs of this program.”

The grant from the Helmsley Charitable Trust will help NYC Health + Hospitals' innovative HoPE program expand its reach to expectant mothers who are experiencing homelessness or imprisoned.

A program launched last year in New York City to address high maternal mortality rates among minorities is getting a $2 million cash infusion to expand its reach to homeless and incarcerated mothers-to-be.

The Leona M. and Harry B. Helmsley Charitable Trust has announced a $2 million, three-year grant to the Arnold Institute for Global Health at the Icahn School of Medicine at Mount Sinai to expand the HoPE (Helping Promote Birth Equity through Community-Based Doula Care) Program, which was launched in 2022 at NYC Health + Hospitals/Elmhurst and Queens.

The funding will help the program expand doula care services to expectant mothers who are homeless or facing housing insecurity, as well as those in prison.

“Right now, New Yorkers experiencing homelessness or incarceration are twice as likely as their housed peers to experience negative birth outcomes,” Tracy Perrizo, the program officer for the Helmsley Charitable Trust’s New York City Program, said in a press release. “At Helmsley, we look for solutions that reduce barriers to care for those with complex needs and limited access to quality services. Expanding doula services for those who are sheltered or incarcerated can improve birth experiences. With continued support from doulas who understand their challenges and needs, we are optimistic that this program can enhance participants’ overall engagement with healthcare and promote long-term well-being for themselves and their children.”

The program is one of hundreds across the country that aim to improve access to care for pregnant women, as well as those who have recently given birth and the children. Through community-based programs as well as telehealth and digital health channels, health systems are offering services and access to resources to those who either can't or won’t seek the care they need.

The HoPE program was launched in a partnership between Elmhurst and Queens hospitals and two doula organizations, Ancient Song Doula Services and the Caribbean Women's Health Association, and is part of a larger program launched in 2018 known as the New York City Partnership.

“With the support from Helmsley, we can better assist our community members who have historically faced disproportionately high adverse childhood experiences, chronic health challenges, limited support during the critical perinatal period, and poor maternal and child health outcomes," Sheela Maru, MD, MPH, an attending physician at NYC Health + Hospitals/Elmhurst and assistant professor of global health and obstetrics, gynecology, and reproductive science at the Icahn School of Medicine, said in the press release. "Community-based doula care offers us a way to change this trajectory.” 

“With funding from Helmsley, the HoPE program will give our patients the opportunity to work with doulas who can support them both in jail and after they return to the community," added Rebecca Giusti, MD, Medical Director of NYC Health + Hospitals/Correctional Health Services' Complex Care and Special Populations division. "I expect that the relationships they build will improve birth experiences and outcomes and further strengthen continuity of care between CHS and H+H hospitals.”

The Pennsylvania health system has eliminated redundant processes and reduced the time and number of people involved in a discharge while boosting patient satisfaction scores.

Patient discharge can be a particularly nasty pain point for hospitals, involving several people from several departments and data from a variety of sources. That, in turn, might make it less than appealing for patients, thus affecting both satisfaction and engagement metrics.

Recognizing the logjams that can occur when leaving the hospital, UPMC has launched a new patient discharge process that consolidates decision-making under one clinical care coordinator and creates a platform for data gathering. The process has shaved 3–4 hours off patient discharge times, improved consult and referral protocols, and boosted HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) scores by almost 10%.

"Our people have become a blended team … with a new boss," says Tami Minnier, MSN, RN, FACHE, FAAN, the Pennsylvania health system's senior vice president of health services and chief quality & operational excellence officer, and the driving force behind the new strategy. "There's a lot that we've been able to improve, and I really think we're only scratching the surface of what we can gain."

Minnier says the patient discharge process had grown cumbersome over time, adding in a variety of check-offs and approvals that built up like gravel gathering along the edges of a streambed. Add in the necessary steps to transfer a patient to a rehab or skilled nursing facility or send a patient home, perhaps with remote patient monitoring services or scheduled follow-up appointments, and patients weren't seeing daylight until late afternoon.

Tami Minnier, MSN, RN, FACHE, FAAN, senior vice president of health services and chief quality & operational excellence officer at UPMC. Photo courtesy UPMC.

"We had created many, many, many different siloed roles around discharging patients from the hospital," she says. "It could take six, seven, eight, nine, 10 people to get just one patient out the door."

Aside from the excessive use of staff and resources, the process also leaves patients and their families waiting to leave the hospital, reducing their satisfaction and, perhaps, causing them to question or avoid post-discharge instructions and follow-up care. Those delays also keep cleaning staff on hold and leave hospital rooms out of commission for longer periods of time.

Minnier's solution was to create one single, accountable, patient discharge manager who oversees a discharge process that involves fewer people. While that might sound easy, it affected more than 700 people within the health system and involved a good deal of change management.

"Change management and culture were the biggest challenges," she says, describing a system that included some "embedded and entrenched" habits and attitudes that needed to be changed. "Getting people to think differently about what they do isn't easy."

"First of all, we had to recognize that anyone can be a good manager," she adds. "The first thing was to say, 'We are all equal,' and then create an integrated care team that understands situational leadership and how to be accountable. Not everything can or has to be delegated."

As part of the process, UPMC developed a new clinical leadership ladder and standardized nursing roles, giving everyone a more streamlined approach to the patient discharge process. The health system also redesigned its weekend compensation program, which reduced on-call costs by more than 50%. Again, the idea was to reduce the number of steps and people involved in getting a patient out the door and back home or wherever they were going next.

"We found a lot of redundant work, [such as] unnecessary consults," Minnier says, estimating the new process cleaned up roughly 157 hours a month of extraneous consults. "We also added cellphones to improve communications, and embedded referrals. We saved hundreds of hours a month there."

They also took a closer look at pending order sets, and reduced labs and other tests (which reduced needle sticks for the patients). They also fine-tuned the protocols for placing patients in rehab and SNFs, with an eye toward reducing the number of times that a patient has been ready for discharge but isn't ready to be received at the next care site.

Minnier says the new process is working well, and the health system is getting ready to publish a study and will present it at major healthcare conferences.

But there's also more to be done. She looks at the network of SNFs, rehab facilities, and other sites that are included in the patient's journey and wants to "build better bridges" with them, so that the transition is smooth and data is shared quickly and efficiently. This would include strengthening communications with health plans, outpatient clinics, and other resources, such as transportation services, behavioral health providers, and social services.

And with the trend of moving more hospital services into the home, Minnier would also like to strengthen the transition for patients to remote patient monitoring and acute care at home programs.