Pre-pandemic plan helps MidMichigan Health complete nearly 50,000 televisits in just six months

Telemedicine has grown by leaps and bounds across the health care industry over the past year. In fact, according to the Centers for Disease Control and Prevention, “during the first quarter of 2020, the number of telemedicine visits increased by 50%, compared with the same period in 2019, with a 154% increase in visits noted in surveillance week 13 in 2020, compared with the same period in 2019.”


Telemedicine – or the ability to distribute health-related services through telecommunication – has enabled doctors to minimize the risk of exposure to COVID-19 for all involved while ensuring their patients receive the care needed to stay healthy. They’ve been able to do video chats, respond to forms submitted by patients, conduct pre-surgical and post-surgical consultations, care for mental health patients, provide routine care, deliver specialty care, and much more!


While some health care organizations were thrust into telemedicine when the COVID-19 pandemic struck, MidMichigan Health had already begun implementing it in 2015 in an effort to better fulfill a mission of providing care close to home for their patients. Learn how this effort prepared them for the pandemic, how doctors at MidMichigan Health are implementing telemedicine today, and what the future may hold for telemedicine.

While MidMichigan Health is seeing a variety of patients through telemedicine, some patients do still need to come into the office. To help prevent the spread of COVID-19 for these patients and the staff, screening precautions are in place.


Telemedicine at MidMichigan Health began long before the COVID-19 pandemic. It began in 2015 with a simple idea: to make health care more accessible and provide quality care closer to home.


“In an effort to be innovative, we wanted to lay the foundation for telemedicine and virtual care for all of our subsidiaries and specifically the rural ones - the ones that might not have access to some of the specialties like neurology, stroke care, behavioral health, and things like that,” says Tom Wood, M.B.A., B.S.N., R.N., director of trauma and virtual care, MidMichigan Health.


Tom Wood, M.B.A., B.S.N., R.N., director of trauma and virtual care, MidMichigan Health.Five years ago, telemedicine was a test project that completed five neurology visits over the course of several months, explains Wood.


“You know what I always give our senior leaders credit for? They believed in that five-visit pilot so much that they invested so heavily - millions of dollars - into telemedicine scaling because they were convinced from just that pilot and a few other things that we built on top of that that this should work,” he says.


And it did work. It didn’t take long for MidMichigan Health to go from a five-visit test project to averaging 20,000 telemedicine visits per year in areas such as stroke care, neurology, infectious diseases, and behavioral health.


“We never really envisioned that a couple of years down the road a pandemic would try the absolute critical nature of our programs; but, prior to COVID, we were one of the higher volume virtual care programs in the state of Michigan,” says Wood. “We had years of experience.”


Prior to the COVID-19 pandemic, MidMichigan Health was primarily using telemedicine to help patients see specialists; however, they were working on expanding their telemedicine services to more primary care patients as well.


“Leading up to the year including COVID, we were already working on the pathways to do what we call direct-to-consumer telemedicine, which is in-home visits where the doctor or provider comes in on a phone, laptop, iPad, or whatever it might be,” Wood explains. “We were actually doing that even prior to COVID; but, what I would say COVID did is took it from something we were trying to do and still figuring out to where it became an absolute necessity for care.”

Steve Blodgett, M.B.A., C.P.M., V.C.-D.S.E., C.T.C., C.H.A.M., manager of virtual care at MidMichigan Health.

Because MidMichigan Health had been working on direct-to-consumer telemedicine prior to the pandemic, they had already worked out a lot of the “bugs” on what worked and what didn’t work. So, when the pandemic hit and forced the organization to implement telemedicine on a larger scale and people to adapt to telemedicine visits, they were able to do so quickly.


“We kind of had a tough time getting adoption with virtual visits or telemedicine initially, but when the pandemic hit and everybody found that it was the way to go, adoption rose and skyrocketed,” says Steve Blodgett, M.B.A., C.P.M., V.C.-D.S.E., C.T.C., C.H.A.M., manager of virtual care at MidMichigan Health. “To give you an idea: Our fiscal year starts in July. We did about 20,000 (televisits) in the fiscal year prior to COVID. In just the first half of this fiscal year, we have already done more than 46,500.”




Today, telemedicine is being implemented in a variety of ways at MidMichigan Health and provides a multitude of benefits to patients, including reducing exposure to COVID-19, providing convenient care for both specialty care and primary care patients, and increasing the likelihood that patients will follow up with routine care.


Utibe Effiong, M.D., M.P.H., internal medicine physician and primary care dyad leader, MidMichigan Health, says, “Lots of patients are worried about having to come face-to-face with their doctor within the confines of our offices because that would mean getting out, interacting with people maybe on buses, and with people who may or may not be sick and shedding the virus that we are all trying to prevent.”

The growth of telemedicine has enabled him and other physicians at MidMichigan Health to ensure their patients continue receiving the medical attention they need throughout the pandemic without being exposed to the COVID-19 virus if it can be avoided.

The growth of telemedicine has enabled physicians at MidMichigan Health to ensure their patients continue receiving the medical attention they need throughout the pandemic without being exposed to the COVID-19 virus if it can be avoided.For Internal Medicine Physician Jinu Puthenparampil, M.D., who works in the South Medical Office with Dr. Effiong at MidMichigan Medical Center – Mt. Pleasant, about 30 percent of his patients each day are seen via televisit.


“I use telemedicine for most of my chronic patients, who have diabetes or something - just to get a follow up on medications, where they're at right now, what are the blood sugar levels,” explains Dr. Puthenparampil. “I don't usually use it for acute patients, you know somebody who has active chest pain or somebody who needs to be examined. I do use it for my patients with depression, anxiety, any kind of mental health issue. And then I use it for patients who can't come in because they are too far away.”


A sign decorates the lawn at MidMichigan Health, encouraging physicians and staff as they come into work each day. The ability to provide care for patients who can’t travel or who would have to travel hundreds of miles to see a specialist continues to be a driving force in the continuation of telemedicine. Since July 2018, Blodgett says telemedicine has saved patients over 1,750,757 miles since they don’t have to travel for those appointments.


Telemedicine has also enabled patients to keep up with their health care despite busy schedules and even the “only-in-Michigan” snowstorms. After a winter snowstorm this year, Dr. Puthenparampil saw the benefit of telemedicine in action. Rather than patients canceling appointments – as they would in years past – many were able to switch their appointment to a televisit.


“We could still do the visit just as it was - we didn't really change anything, but we talked on the phone and we checked in,” he says. “I think that was really helpful for both the patient and me, because I could check how they were instead of waiting for a month to get rescheduled.”


He adds that patients are really beginning to like televisits due to their convenience and the flexibility they offer.


“They can be in an office, they can be in school; all they need to do is take a 20-minute break and talk to us via video and then they can go back to what they were doing,” says Dr. Puthenparampil. “They don't have to come into the office; there are no long waits.”

Utibe Effiong, M.D., M.P.H., internal medicine physician and primary care dyad leader, MidMichigan Health, alongside Internal Medicine Physician Jinu Puthenparampil, M.D., at MidMichigan Medical Center – Mt. Pleasant.

Furthermore, because patients can easily schedule their own appointments online, see their own doctor quickly, and do so conveniently, the health of patients on the whole benefits.


“If you are able to connect with your doctor whenever you need to and you don't have to travel and can easily schedule, you're more likely to connect with your doctor, you're more likely to save your health, and you're more likely to follow up with things that you're supposed to,” says Dr. Effiong.



While telemedicine has grown by leaps and bounds over the past year, the opportunities to continue doing so are nearly endless.


“I think we've only scratched the surface on what telemedicine can do,” says Wood.


However, the future of telemedicine largely depends on government regulations and the willingness of insurance agencies to continue paying for telemedicine services. Prior to the COVID-19 pandemic, government regulations and the lack of interest by insurance companies to pay for those services were two factors delaying the growth of telemedicine, explains Wood. The pandemic forced both the government and insurance agencies to move forward. One of the questions that remains now is: Will they continue to accept progress once the pandemic is resolved?
Robyn Sabol, R.N., at MidMichigan Health, sets up a telemedicine visit with a patient while Dr. Utibe Effiong looks on.

“Before the pandemic, some primary care doctors could do your health visits through video, but to do so you were asking patients to go from a visit that their insurance covered to one that they had to pay for out-of-pocket or asking the doctor to go from a visit that's billable to one that they have to do for free,” he says. “Patients aren't going to choose that and that's not a sustainable model for a doctor functioning in the community.”


“If the services are here to stay, which our patients want them to, our doctors want them to, the hospitals want them to, and we want them to, then we need support from insurance companies and regulators to keep it that way.”
While telemedicine expanded over the past year, it was already being implemented across MidMichigan Health prior to the pandemic in an effort to provide quality care closer to home for patients.


The importance of telemedicine in the health care industry cannot be underscored enough – especially for rural communities.


“Telemedicine allows us to fulfill our mission - it allows us to stay true to our vision of providing the best quality care close to home,” says Dr. Effiong.


However, it’s important to remember, says Wood, that telemedicine isn’t taking away other health care options – it’s only adding them. It’s not taking away the ability to see a doctor in person and there are no plans to do that.


“It just gives patients the care how they want it, when they want it,” he explains. “They can choose virtual care, they can choose to go to the urgent care, they can choose to wait for their doctor, they can choose to fill out a template on our patient portal and submit it and wait a day or two to hear back from the doctor. It's about giving them a choice, and about empowering them to take care of themselves. The purpose of MidMichigan Health is creating healthy communities together and virtual care is partnering with our patients in the community to say, together, 'How would you like to access your health care?’”

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