The options for having a doctor’s visit without physically visiting a doctor have been expanding for years in Alaska. Now, the pandemic has shifted the expansion into overdrive.
Over the last month, a federal emergency order, a new state law, and a state health insurance policy change have relaxed a lot of technical and financial barriers to use telehealth for tens of thousands of Alaskans.
For many, telehealth will be free — and available for a much wider range of services — during the pandemic emergency.
Laura Jim goes to SEARHC, a tribal health care provider for Southeast Alaska, for her health care. She recently recovered from having COVID-19. Aside from getting swabbed for testing, her primary care was all virtual.
“It was, um, it’s a little different,” she said, hesitantly. Similar to a Zoom meeting. “They send me an email with the link. And I click on the link and download the program … super easy.”
She took her own temperature and pulse for a nurse.
“And then she brought me — just like a doctor, you know — brought me into a room. … And, so I was like, in a room through the video. And then the doctor would walk into the room (with) the laptop that was sitting there with my face on it. And then I met with the doctor.”
That’s one form of telemedicine. Doctor’s visits can be done without good internet over phone calls or email, too. Before the pandemic, there were technical security requirements that limited how parties could connect. For example, you might have had to leave home and go to a special office with a secure internet connection.
Last month, President Donald Trump’s administration relaxed some of those technical requirements for Medicare patients.
“Medicare patients can now visit any doctor by phone or video conference at no additional cost, including with commonly-used services like FaceTime and Skype — a historic breakthrough,” Trump said during a White House press conference. “And by doing this, the patient is not seeing the doctor, per se, but they’re seeing the doctor. So there’s no getting close.”
Which is good, because you can’t spread diseases over video.
In Alaska, Medicare covered more than 96,000 people as of 2018.
Destiny Sargeant is a clinical psychologist with a private practice in Juneau. She was licensed for telemedicine before the pandemic. Sometimes, she’d work with veterans who live out of town.
Now, “Because of COVID, I took all my people that I was seeing in Juneau and converted everybody now to telemedicine, and it seems to be working pretty well for most. Sometimes the thought is a little scary for people. But as you can see,” she said, while talking over a webcam, “we can still read body language, and it takes about 10 minutes and we would almost forget … and you can actually make a connection with people and still actually do really good therapy. So it seems to be working better than my wildest of expectations.”
Sargeant said she prefers seeing people in person. But videoconferencing is the next best thing.
“I was one of those die-hard people 10 years ago when it wasn’t a common thing. I thought I probably had as much resistance as almost anybody else,” she said.
She said it wasn’t as satisfying at first, but she got over it. It also gave her some new ways to make therapeutic connections, like having a patient include their pet or discussing a piece of art spotted in their home.
“I find that it really works, and I’ll probably be at it for a very long time,” Sargeant said.
A lot of the telehealth freebies are tied to official emergency or disaster declarations. Once they’ve ended, free telehealth will, too.
For example, the state temporarily expanded access to Teladoc for about 90,000 people covered by AlaskaCare. It’s mostly retired public employees and their dependents, as well as a lot of current state workers and their dependents, according to Emily Ricci, chief health administrator for the state Division of Retirement and Benefits.
Teladoc isn’t a generic term, but one specific company. A representative said Alaska-specific usage data isn’t readily available. Nationally, however, a March 13 press release said the volume of visits shot up 50% that week. More than half of the Teladoc visits were from first-time users.
One lasting change is a new requirement for insurance plans in Alaska sold on the individual health care exchange. A new state law took effect March 17, requiring those plans cover telehealth services.