1. School-Based Telehealth Clinics in Indiana
Improving access to care for Children

2. Speakers Sarah Thompson, MPH Hayley Ready Heather Gordon
School-Based Services Administrator
Managed Health Services (MHS)
Hayley Ready
Rural Community Outreach Coordinator
Indiana Rural Health Association
Heather Gordon
Elwood Intermediate School Nurse
Introduce ourselves

3. Learning Objectives
Ability to communicate the importance, relevance, and benefits of school-based telehealth clinics
Ability to identify the viability and sustainability of school-based telehealth clinics
Ability to identify the key partners and processes necessary to establish a school-based telehealth clinic in your community
Hayley

4. School-Based Health Centers 101 (SBHCs)
ONSITE
Nurse Practitioner or Medical Doctor located on school grounds to diagnose and treat students.
Within school, mobile
Staff and community members can also be seen if allowed
Around 30 or less SBHCs in Indiana
Over half located in Central Indiana
4 school-based telehealth centers have launched since 2016
TELEHEALTH
The use of electronic information and telecommunications technologies to support long distance clinical health care.
In the school setting, the school nurse acts as the ‘presenter’ and uses the diagnostic tools so that the provider can conduct a virtual visit.
Hub site- Location where provider is
Spoke site- Location where patient is
Sarah
Easy access, no/low-cost care, range of services, supportive relationships
Removes barriers such as access to care and transportation: meets the students where they are
Attract hard to reach populations
Cost effective investment: proven to reduce, inappropriate ER use and hospitalization rates, as well as increase use of primary care.
Attract hard to reach populations: especially males and minorities
Meet students where they are: to provide care to those with or without a medical home.
Increase access to healthcare for medically underserved children and families.
Opportunity to reduce barriers to health and behavioral services to children and their families.
Increase awareness and education about health and behavioral issues in the community.

5. Why Telehealth? Research Supports It Addresses Current Barriers
Researchers showed that a school telehealth clinic reduced student absences due to illness by 63%, most likely attributable to early diagnosis and treatment (McConnochie et al., 2005).
In two different studies, parents highlighted not missing work and convenience of time saved by telehealth was appreciated (McConnocie et al., 2005; McConnochie et al., 2010).
Space for an actual clinic area
Funding for brick and mortar expenses
Sustainability for sponsoring agency
Shortage of providers (especially in rural areas)
Sarah
Indiana faces barriers such as no funding for brick and mortar, schools have no space, sustainability, and in rural areas shortage of providers
Pulled from meta analysis
ECSC address is a Health Professions Shortage Area in Primary Care by HRSA

6. Partners for the Pilot Elwood Community School Corporation
St. Vincent Mercy
Aspire Indiana
Managed Health Services (MHS)
Indiana Rural Health Association (IRHA)
Hayley
Opportunity to explore within own community potential partners
What partners should be involved to make an initiative like this happen?
How are partnership formed?
How did our partnership form?

7. Telehealth Clinic Model
Sponsoring Agencies
Physical Health- St. Vincent Medical Group (Dr. Robert Zentz)
Provides supplies to school nurse for limited lab testing
Behavioral Health- Aspire Indiana
Funding Agencies for Equipment
MHS- Intermediate/Jr.-Sr. High School
IRHA- Elementary School
School Involvement
Equipment is housed in the school nurse’s office
The school nurse is the ‘presenter’
Hayley

8. Elwood, In COMMUNITY DATA SCHOOL DATA
Population (2015 est) ,455
White alone (Apr 2010) %
Bachelor’s degree or higher (‘11-’15) %
Persons without health insurance (65 ) %
Persons in poverty %
Access to Care
SCHOOL DATA
3 school (elementary, intermediate, jr.-sr. high school)
Enrollment3 1,657
Free Meals %
Reduced Price Meals 9.5%
Avg Attendance Rate3 95%
Heather
Sources:
United States Census Bureau (
2015 American Community Survey, 5 year estimates (
Indiana Department of Education DOE Compass (compass.doe.in.gov)

9. Telehealth Clinic Model
Heather (Physical Health)
Sarah (Behavioral Health) Aspire picture connects to Aspire Marketing Video
Here is where we can give the most up to date number of visits with Dr. Zentz and Aspire. Can also break down by diagnosis and payor…potentially
Physical Health Behavioral Health

10. School Nurse Perspective
Role of the School Nurse
Time Commitment
Length of typical appointment
How it affects other responsibilities
Equipment
Includes a laptop, digital camera, stethoscope, otoscope, and dermascope that plug into the computer
Heather
Role
Decide if telehealth is appropriate for the child
Advocate the program to parents/families
Time Commitment
Length of typical appointment
How it affects other responsibilities
Equipment
Ease of use

11. Telehealth Clinic Model- Billing
Will the visit be paid for by commercial insurance and Medicaid? YES
MEDICAID
Location code- 03 (Determines it is a school-based health center)
Normal CPT codes are used with the GT Modifier added (denotes telemedicine services)
Providers will bill for services provided at the hub site (where provider is)
Indiana reimburses for telemedicine services according to the IHCP’s universal fee schedule
FQHCs and RHCs- reimbursement is based on the PPS rate specific to that facility
Must update scope of area and be identified as a stand alone site to receive same rate
Sarah (Brief)
School does not handle billing. Billing is done by the provider.
No one is turned away. If person does not have insurance, the clinic works with CKF Madison County to work to get them insured. (DATA from Julie)
Hindrance of 20 mile rule initially- MCOs agreed to waive that and still pay. Now with new legislation about to pass, this shouldn’t be a problem. House Bill 1337; also removes limitations on prescribing controlled substances except for opioids through the use of telemedicine
House Bill Provides for coverage of telemedicine services under a policy of accident and sickness insurance and a health maintenance organization contract. Effective July 1, 2015.
FQHCs can not include reporting measures on the UDS report (cost report).

12. HIPPA and FERPA
HIPPA- Health Insurance Portability and Accountability Act of 1996
FERPA- Family Educational Rights and Privacy Act
“Some outside parties provide services directly to students and are not employed by, under contract to, or otherwise acting on behalf of the school. In these circumstances, these records are not ‘education records’ subject to FERPA, even if the services are provided on school grounds, because the party creating and maintaining the records is not acting on behalf of the school. For example, the records created by a public health nurse who provides immunizations or other health services to students on school grounds or otherwise in connection with school activities but who is not acting on behalf of the school would not be ‘education records’ under FERPA”.
HIPAA or FERPA? A Primer on Sharing School Health Information in Indiana -
Sarah
HIPPA- protects the privacy of patient health information
FERPA- protects the privacy of students’ personal records
A school health program’s records are subject to FERPA if the program is funding, administered and operated by or on behalf of a school or educational institution.
A school health program’s records are subject to HIPAA if the program is funded, administered and operated by or on behalf of a public or private health, social services, or other non-educational agency or individual.

13. Work Plan
Outline of the scope of the project and includes outcomes and processes by which the planning committee can accomplish those outcomes. The Elwood School-Based Telehealth Initiative Work Plan consists of:
Key Partners
Scope of Project
Outcomes
Tasks to Accomplish
Resources Required
Accountable Parties
Target Time Frame
Progress Notes
Sarah (Brief)
Addresses learning objective #3- the ability to create a plan that is unique to their school community

14. Outcomes Establish Internal and External Planning Committee
Establishment of subcommittees
Assessing Community and School Needs
Parent Surveys
Student Surveys (if applicable)
School Staff Surveys
Securing Community Support and Establishing Goals
Evaluating Resources
Configuring Logistics, Defining Operations, and Developing Policies and Forms
Training Staff
Informing Parents
Launching the Clinic
Sarah (Brief)
Establishing Planning Committee:
School, Provider(s), IT, Marketing, Community Agencies, MCOs
Assessing Community and School Needs
Utilizing Survey Monkey, paper copies
Securing Community Support and Establishing Goals
Buy in from school board and school community. Media exposure for marketing help
What goals are needed to be set to ensure successful outcomes?
Evaluating Resources
What is currently available in the community?
What is missing?
Configuring logistics, operations, policies and forms
What needs to be done logistically to make this happen? Spacing, equipment, IT, etc
Operations- Based on assessments and resources, what will the operations look like for this clinic?
Policies and Forms- Will the clinic follow the provider’s already established P&P? What specific policies will need to be developed for school clinic? Ie. Does verbal consent have to be received in addition to written consent?
Training Staff
Making sure staff are well trained on the equipment
Training school staff and provider together to ensure they feel comfortable working together
Informing parents
This needs to happen over and over and over
Written and verbal information needs to be provided multiple times
Launching the Clinic
Set a realistic timeframe to launch clinic
Just because it opens does not mean people will come
Launch when all pieces are in place

15. Implementation Timeline
Sarah
Hayley- to speak to the length of other implementation timelines
NOTE- Timeframe from initial interest meeting and executed MOU 7 months

16. Ribbon Cutting Information
Brochure
Presentations
Surveys
Sarah
Resources and Tools used during the implementation-
Provide resources for participants to take
Enrollment Packet
Ribbon Cutting Information
MOU

17. Return on Investment (ROI)
Partner
Return on Investment
Elwood Community School Corp
Decrease in absences
Increase in seat time
Decrease in behavioral health issues
St. Vincent- Mercy
Decrease in inappropriate ER use
Increase in access to care
Increase in patient load
Increase in primary care and vaccinations
MHS
Increase in access to care for our members (physical and behavioral health)
Increase in continuity of care
Aspire
Increase in continuity of care for current patients
IRHA
Increase in access to care in rural settings
Sarah
Aligns to each of our missions
Integration of other healthcare/educational opportunities- additional partnerships
All can chime in on ROI for specific agency

18. Data Collection- ROI
Total number of SBTHC users by insurance status, age, etc.
Number of visits by type/diagnosis
Number of referrals to specialists or community partners
Number of continued behavioral health services after initial referral
Change in ER utilization
Change of attendance rates
Customer service satisfaction (patient, parent, teacher, school nurse)
Sarah
Within the subcommittee, we identified who will collect what, the frequency of data collection, and methods to share.
Make point HIPAA and FERPA is not being violated

19. Best Practices and Lessons Learned
Have key players on board
School (Superintendent, Board, Principal, Nurse!!!)
Provider
Support agencies
Have the right people at the table
Decision makers
Supporters, Those who have a vested interest
Users
Know your audience
Understanding of who they trust, who they will listen to, best way they receive information IT
Firewalls, Security, Etc.
Hayley
Marketing at events and in the community is key
Allow for each speaker to talk about best practices and lessons learned from their own perspective

20. Click on Dr. Zentz’s picture to see the WTHR interview

21. Ongoing Efforts Continued quality improvement Continued marketing
Steered from data
Increasing utilization
Continued marketing
Enrollment opportunities
Information sharing
Continued partnership with school corporation
MHS’ Adopt-A-School Program; sponsorship of school-related programs/events
IRHA’s Indiana Rural Schools Clinic Network
Sarah/Hayley

22. Indiana Rural Schools Clinic Network (IRSCN)
MISSION: Dedicated to increasing access to primary care through telehealth for students in rural schools
Indiana Rural Health Association
Established by two Health Resources and Services Administration (HRSA) grants
HRSA Rural Health Network Planning Grant ( )
HRSA Telehealth Network Program Grant ( )
States Awarded: AL, AR, CT, IN, KS, KY, MD, MI, MN, MT, NC, NM, NY, SD, TN, VA, WA, WI, and WV
List of Awardees found here:
Hayley

23. Participation in IRSCN
Schools that participate in IRSCN receive:
Funding for telehealth equipment
Guidance in establishing a school-based telehealth clinic
Marketing of the program
Opportunity to hear/share lessons learned and best practices with other Network Members
School Members
Community Members
Elwood Community School Corp
St. Vincent- Mercy
Crothersville Community Schools
Southern Indiana Rural Health Clinic
Southwest Jefferson School Corp
Managed Health Services (MHS)
Scott County District 1 School Corp
Bloomington Meadows Hospital
Aspire Indiana
Hayley
Discuss other funding sources as well
Opportunity to discuss briefly variance in models (ie: School staff presenting at Crothersville since no school nurse on staff, also sponsoring agency is not a hospital)

24. Additional School-Based Telehealth Clinics
School Year
Through the ISCRN grant
MHS sponsorship
School Corporation
Sponsoring Agency
North Vermillion Community School Corp
Valley Professionals Community Health Center
Oregon-Davis School Corp
HealthLinc Community Health Center
E. Washington School Corp
St. Vincent- Salem
W. Washington School Corp
Salem Community Schools
Mississinewa Community Schools
Marion General Hospital; Family Services of Grant County
Hayley/Sarah
IRSCN logo – link to video
Hayley to walk through how to apply for funds
School Corporation
Sponsoring Agency
Valparaiso Community Schools
HealthLinc Community Health Center

25. Questions?