Network Spotlight: Illinois Telehealth Network
|Network Name||Illinois Telehealth Network (ITN)|
Gurpreet Mander, MD, MBA, CPE, FAAP, Executive Director, Illinois Telehealth Network; Julie Edwards, MBA, Network Director, Illinois Telehealth Network; Erin Kochan, MBA, Project Director, Illinois Telehealth Network; David Mortimer, MDiv, Sustainability and Development Director, Illinois Telehealth Network
|Mission||ITN promotes the capacity of Members to improve access to health care in rural, underserved and disadvantaged communities, through the application of telehealth and telemedicine solutions.|
ITN will connect and share resources, strengthen rural health care and save lives.
Dr. Gurpreet Mander, Julie Edwards, and David Mortimer of the Illinois Telehealth Network were interviewed by the Network TA team to share information on the network’s characteristics, key learnings, accomplishments, and challenges.
Q: In a nutshell, how would you describe your network?
A: The Illinois Telehealth Network can be best viewed as a collaborative or consortium of 26 rural health entities, which include hospitals (large and critical access), physician groups, FQHCs, and an ACO.
Q: What benefits do network members receive?
A: Network members have access to resources and expertise from rural health network and telemedicine associations and from expert ITN staff, supported by an Executive Director, board, and Advisors with state, regional and national expertise. Most network members are small or rural hospitals. A lot of those facilities have challenges in capacity to be able to seek grant funding or construct and plan and operationalize a new program that may be a new technology, sometimes even a new service line, look at vendors and equipment, and navigate the legal complexities, or even figure out the reimbursement piece of telemedicine. Through different economies of scale and sharing equipment, or combining efforts to go after competitive foundation or federal grant funding to secure equipment, we collaborate and provide resources to members.
Network members also see benefit from a clinical and operations side, and in collaboration to share care delivery protocols. For example, our emergency department tele-stroke care (tele-neurology) has improved care quality, expedited decisions and improved door-to-needle times for our stroke patients throughout the region. Standardized telemedicine equipment is another benefit for our members in terms of collaborating around those services and getting better price points, as well as providing more consistent care to a rural population.
As a learning community, the network is designed to be a home for innovation to incubate small test pilots, supported by philanthropy or grants. Success is then scaled and expanded. Future member benefits will include exploring opportunities for shared savings, group purchasing, and ITN-negotiated vendor discounts for telemedicine services and equipment. (Experience shows that higher patient volumes can help secure better pricing.)
Q: What challenges do you face working in rural health care?
A: The lack of resources and technical know-how is a steep challenge. About five years ago, when the network was launched, we conducted a needs assessment, and results demonstrated that there was limited awareness that telemedicine and telehealth could be part of the solution to improving access in the region or expanding an organization’s business model. A lot of what the network has accomplished over the years is to share a depth of knowledge and experience around telehealth.
Another challenge is the high cost of equipment. Costs are getting lower, but they can be a huge challenge for a cash-strapped critical access hospital or a hospital with unpaid bills due from the state. As we've moved and progressed into expanding our services, what we've found are the “next-step” challenges, such as how to credential physicians and bill providers. Being able to navigate reimbursement for these services can be a huge challenge for smaller hospitals that may have limited resources. It’s an emerging technology, and the regulations and processes are still being defined.
In the very beginning of network planning, the first challenge was to establish a mission statement so that everybody was on the same page and agreed with the objectives we were trying to accomplish. In the first several months, with the help of an external consultant, we were able to get all the rural hospital stakeholders around the table, and they drafted a mission and vision that are standing the test of time.
The network’s mission is all about access. It's all about helping bridge that digital divide and helping alleviate what is known as a “rural penalty” that rural-dwellers experience every day. These rural-dwellers are often people that have no service or data for a cellphone, or may not even have dial-up in some areas to provide basic internet. This digital divide impacts many areas of life, but also severely limits their means to connect to healthcare providers. Some rural hospitals are even challenged with their broadband capacity and connectivity. With more and more of our health care provided through remote monitoring or through telemedicine to rural hospitals, it’s important to bridge the gap and find ways to work around these digital divide challenges.
Q: On the other side of things, what are the advantages of working in your rural area?
A: The purpose of a network is to serve the common good. An advantage we experienced is that our members are very engaged in collaboration, because they understand the substantial advantages to their own organizations. Some network members are competitors, but we’re finding that even competitors find tangible benefits when they rely on each other in a variety of different areas. It’s extremely helpful when a core network team member is familiar with philanthropy or an expert in federal grant development. It’s also helpful to have an engaged foundation that is passionate about your mission and that may commit matching funds to help leverage a grant application.
Q: What has been a surprising insight over the course of your network’s development?
A: One surprise happened in the first year, when we began getting network stakeholders around the table to plan and discuss needs assessment findings. We learned that most of us were facing similar challenges: provider shortages, difficulties in recruiting and providing specialty services. Rural hospitals were losing patients to bigger city hospitals due to transfers. Our members experienced many challenges, but one surprise was that many of our rural hospitals thought they were not bringing much to the table to benefit the larger group.
It turns out that some of the more rural, small-town hospitals brought great value to the table because of their geographic location. Although they didn’t have the staff or consultants or capacity to put together their own federal grant application, they scored very high on certain grant application because of their geographic location. What they brought to the table in participating in a collaborative grant application was extremely valuable to other network members. Their participation in the network meant a collaborative grant application that may have scored high because it included stakeholders serving very rural or hard-to-reach underserved populations.
Q: Based on your experiences as network leaders, what advice would you give to a developing rural health network?
A: The best advice is this: When you have engaged members, begin to collaboratively build some level of structure. Operationally, have flexibility with ideas to accommodate unique member needs. Things change—people and roles—and needs change as time goes on. When a need or opportunity is not clearly defined, leaders and outside experts are critical to bring definition and focus. Also, it’s important to stay true to your mission and your vision. As a network grows, relationships can become very complex, so you need to stay focused on your core mission and vision of being a collaborative for the greater good. Along with continually demonstrating value, a constant connection to mission keeps the members engaged in order to achieve efficiencies, leverage economies of scale and share successes.
Another key to success is investment of time. It takes a lot of time to get stakeholders around the table, and if stakeholders are busy c-suite representatives of their organizations, it’s vital to respect their time. Also, when a network has members that are competitors, it often means those members are highly engaged because they realize they could easily miss out on a valuable opportunity if they're not attending meetings. Bylaws, formal organization, a board, incorporation as a nonprofit—those are all critical for networks, but what we have found in the Illinois Telehealth Network over the past four years, is that annual needs assessments are critical, because the facts on the ground frequently change and new members are always onboarding into the network.
Lastly, having a dedicated and committed team is critical, along with champions to tirelessly push things forward and keep momentum. When members are engaged, extraordinary things happen, and everyone in the network is able to do more with less.