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How Arizona's medical community is using telehealth during COVID-19, and plan to use it after

Doctor generic
Posted at 2:32 PM, Apr 10, 2020
and last updated 2020-04-13 16:29:11-04

PHOENIX — The COVID-19 pandemic has caused a massive shift in society, changing the structure of everyday life in the United States.

According to the CDC on Friday, the U.S had 427,460 cases of coronavirus, 3,112 of which are located in Arizona, according to the Arizona Department of Health Services (AZDHS).

Arizona is one of the forty-four states that have issued shelter-in-place orders, including Washington D.C. and Puerto Rico to try to "flatten the curve."

The drastic switch to social distancing and quarantine can be overwhelming for many.

The stress of outbreaks can result in changes in sleeping or eating patterns, difficulty concentrating, worsening of mental health conditions and the increased use of alcohol, tobacco, or other drugs, according to the CDC.

“...We have to respond to these unexpected things that we're all experiencing,” Alicia Cowdrey, outpatient medical director at Valleywise Health said. “There's a lot of fear, anxiety and grief that goes along with what we’re all experiencing because of the unknown and the loss of some of our ability to do things.”

While many Americans are waiting to return to a normal society, the director of the National Institute of Allergy and Infectious Diseases, Anthony Fauci, said that might not be realistic for a while.

"If 'back to normal' means acting like there never was a coronavirus problem, I don't think that's going to happen until we do have a situation where you can completely protect the population," Fauci said at a previous White House briefing. "When we get back to normal, we will go back to the point where we can function as a society.”

Executive order signed for telehealth

Currently, Arizona ranks 36 out of 50 states when it comes to access to mental healthcare, according to the non-profit Mental Health America.

On March 25, Governor Ducey signed an executive order requiring health insurance companies to cover the cost through telemedicine if the healthcare service would have been performed in-person.

“Access to health care is crucial at a time like this,” Ducey said in a statement, included in a news release about the order. “This order will ensure that Arizonans can access care without having to leave home while freeing up much-needed capacity for our health care providers and hospitals."

This order includes the coverage of telemedicine for most mental health care providers as well, a treatment option that wasn’t covered by most insurance providers before.

Treatment goes virtual

Alevea Mental Health is a clinic located near ASU’s Tempe Campus that manages over 2,000 patients and has recently transitioned entirely to telemedicine as a recommendation from AZDHS.

Topher Bradshaw, a certified physician assistant at Alevea Mental Health, noted that the telemedicine program has always been available, however, this has been their primary means to see patients over the past 3-4 weeks due to COVID-19.

“We have noticed an increased demand in our services which we contribute to primary care clinics having limited availability and the obvious, anxiety symptoms directly related to COVID-19,” said Bradshaw. “...The uncertainty and outcome of this historic pandemic is certainly real and tangible for the community and not just those dealing with mental health conditions.”

Several other healthcare facilities have made the switch to telehealth and virtual treatment, including Copa Health.

Copa Health treats community members with special needs, mental and physical health.

“Social distancing obviously is inconsistent with what we do in the mental health arena as far as promoting social connectedness and so, we had to become extremely creative in ways in which we're going to empower and advocate for social connectedness, i.e. the telehealth strategy," Shar Najafi-Piper, CEO of Copa health said. “So, in one of our programs we are launching music and
Zumba classes virtually for our members that used to come into our day programs.”

Larry Villano, the CEO of Resilient Health, said that even temporarily removing restrictions that allow healthcare providers to perform services via telehealth allows them to experiment in "ways that we've never really been able to."

"We've never had an opportunity to do group counseling over telehealth until now, and now we have that opportunity," he said. "And that's the kind of innovative programming that we're doing."

Mental healthcare probably does not seem like a priority due to the chaos surrounding events but that’s why it’s important Lauren Jones Goldbach, a licensed clinical social worker at East Valley Trauma Counseling said.

“It’s also not a priority until it becomes a mental health crisis, right now everyone is in survival mode,” she said. “We're not going to be thinking I need to reach out, I need to get help, I need to schedule with my therapist. We're thinking ‘where are we going to get toilet paper? The food’s off the shelves, are my kids going to be able to eat?’ When I do reach out to some of the clients are like, ‘Oh, crap! I meant to schedule, but I’ve just been sucked into this nightmare we're all experiencing.’

Healthcare after COVID-19

Goldbach said the mental healthcare community is preparing for an intense increase in demand for treatment after the pandemic.

“What we're all predicting in the community is a massive, massive trauma response and acute stress response, to this event,” she said. “Just for everybody, including the health care workers and the first responders. And by the time everybody realizes they're going to need some level of help; we're going to be looking at a situation again where you're on a waitlist to get into a counselor. Maintaining a relationship with someone you can reach out to during this time is, I think, paramount. But it's not the first thing on our mind.”

Shar Najafi-Piper, CEO of Copa health, said that there will be an increase in those that enroll in Medicaid and those that access mental health services.

“I'm on a task force with the state where we're already preparing for not just now, but when the pandemic comes and leaves Arizona. Hopefully in the next couple weeks, we will be prepared to take on additional enrolled members,” Najafi-Piper said.

Najafi-Piper said a majority of those who are calling into the crisis line are talking about symptoms “of depression, anxiety related to being laid off or related to social isolation.”

Future of telehealth

Before the legislation passed by Governor Ducey, most insurance companies didn’t cover the cost of telehealth. Topher Bradshaw believes the executive order the Governor implemented should remain in place after the fact, and that it is important to remove “any unnecessary barriers of providing telehealth” legislatively.
Copa Health’s Shar Najafi-Piper shared the benefits from a business standpoint.

“This pandemic will be the catalyst for telehealth for our company and it's in a good way” Najafi-Piper said. “We can penetrate new markets, without having to physically build a brick and mortar clinic.”

Valleywise Health’s Alicia Cowdrey said that telehealth was important for accessibility and those in rural Arizona.

“There are people in rural Arizona that don't have access to the same treatment that a person might have in Maricopa County,” Cowdrey said. “Even if they are in Maricopa County, that person might not have transportation that’s reliable to get them to an appointment. I really think this is going to increase the efficiency and the access to mental health treatment for Americans, as well as decrease the amount of stigma associated with mental health conditions.”

RESOURCES

If you are experiencing feelings or signs of depression or suicide, or know someone who might be, there are people and resources available.