From the darkness, good can come.
As communities battled the challenges of the COVID-19 pandemic, a more positive health care trend burgeoned — the use of telehealth.
Especially in rural areas, where hospitals, clinics and providers can be scarce, telehealth and related programs are playing a significant role in helping Alabama communities become healthier.
Auburn University’s Rural Health Initiative has been integral to this effort, which has included partnerships with government entities, other universities, local providers including hospitals, and local communities. The program is led by Auburn University Outreach and Alabama Cooperative Extension System.
Program implementation began in March 2023 with the opening of an OnMed CareStation in LaFayette in Chambers County. It sits inside the Chambers County Community Health and Wellness Center. From its start through Oct. 31, 2024, the telehealth station has totaled 1,751 patient visits, according to Hollie Cost, assistant vice president of university outreach and public service at AU.
Since the LaFayette opening, OnMed clinics have been set up in Greene, Hale and Wilcox counties, Cost notes. Patients use the small clinics-in-a-box for free, thanks to funding provided by the American Rescue Plan Act (the formal name of COVID-19 relief funds).
According to the OnMed website, the clinics provide “comprehensive, everyday health care” similar to a typical primary care visit. Once a patient is inside the private and secure station, the person hits “start” on the screen. A video call with a certified clinician soon begins, lasting about 20 minutes.
The patient is able to check his own temperature, blood pressure, pulse and more with equipment provided inside the clinic. The clinician provides a diagnosis and treatment plan and, if needed, e-prescriptions that can be filled at a local pharmacy. The station undergoes a cleaning and sanitation cycle after each patient visit.
According to a Rural Health Initiative summary shared by Cost, Alabama ranked 44th nationally in health care in 2023, per a U.S. News & World Report article.
“We recognize the significant health disparity throughout rural Alabama,” Cost says. “As a land grant institution, it is part of our mission to be committed to leveraging our resources [to help with this disparity]. These are literally peoples’ lives. We have a mission to do this, but we also have a moral obligation.”
As noted in the Rural Health Initiative summary, communities targeted for the program must fall within the bottom 50% of the state in health factors and health outcomes, have a considerable physician shortage and have limited access to health care.
Along with the OnMed stations, the initiative offers telehealth carts in Clay, Randolph, Coosa, Tallapoosa, Elmore, Macon, Bullock, Barbour and Chambers counties. With funding provided by a telemedicine grant from the U.S. Department of Agriculture, the carts provide mental health services, substance use disorder treatment and primary care by Alabama providers, Cost says.
The Rural Health Initiative takes a communal approach to its work, going beyond telehealth. For example, “community ambassadors,” from high school students to retired health care professionals, volunteer to educate citizens on topics like maternal health and wellness, Cost explains. AU faculty, staff and students provide weekly speech and hearing screenings and services at the Chambers County Community Health and Wellness Center.
The initiative also helps with local food pantries and “closets” where citizens can receive period care products. Another closet is being developed that will offer maternal care products and diapers in Chambers County, Cost says.
Tuskegee University also is lending a health care hand to its community. In September 2024, the university added an OnMed CareStation to its campus in the atrium of Margaret Murray Washington Hall. The station is open to students, faculty and staff, but with help from the school’s Center for Rural Health and Economic Equity, the station can be used for free by citizens of the community and Macon County.
COVID-19 and the Rise of Telehealth
While telehealth existed before the pandemic, it only played a small role in delivering health care, according to a Blue Cross and Blue Shield of Alabama leader. “COVID is where it was brought to the forefront,” says Dr. Darrel Weaver, vice president, provider engagement and support.
When the pandemic started in mid-March 2020, doctors couldn’t have as many face-to-face visits with patients, Weaver explains. Likewise, patients were wary of going to doctors’ offices and hospitals for fear of getting sick.
“So, the medical world and Blue Cross and Blue Shield of Alabama realized very quickly it was going to be very important to promote and allow telehealth. We also realized that it wasn’t complicated — we just needed to enable it,” Weaver says.
The use of telehealth exploded across both medical and behavioral health segments.
Telehealth medical claims increased from approximately 2,000 per week to almost 80,000 per week, according to Weaver. As the pandemic waned, telehealth medical claims decreased, ranging from 15,000 to 20,000 claims per week. Medical care via telehealth now accounts for about 5% of claims, Weaver says.
The number of behavioral telehealth claims at BCBS also rose during the pandemic. Today, about half of behavioral health care is delivered through telehealth visits, Weaver notes, and these claims continue to rise. “This is where telehealth really came into its own and continues to make a major impact,” he says. “[Telehealth] has been amazing for behavioral health due to increasing access regardless of physical location and allowing for care without any uncomfortable interactions in a waiting room.”
Telehealth overall also played a significant role in rural areas during the pandemic. “Patients were able to reach out to providers pretty much anywhere in the state, and it made it much easier for them to get the care they needed,” Weaver notes. “We are still seeing that today. Telehealth was and still is a great equalizer for people living in medically underserved areas. I see telehealth becoming more important as access to care decreases in rural or nonmetropolitan areas of our state.”
As BCBS has managed its way through the telehealth journey, it has had some “aha” moments. Procedures requiring more direct care or monitoring aren’t good candidates for telehealth, Weaver notes.
“What could be done by telehealth surprised us,” he says. “When telehealth first launched, we asked ourselves, ‘how could physical therapy be administered by telehealth?’ But telehealth provided a way. With video, even after someone has knee surgery, you can ask to see their knee and from there work on having them bend their joints and work on increasing their range of motion,” Weaver explains.
The future of telehealth is unknown as federal government policies supporting it could change with the incoming Trump administration. The work of Auburn and Tuskegee universities could become even more important in helping rural Alabama communities meet their health care needs.
Nancy R. Randall is a Tuscaloosa-based freelance contributor to Business Alabama.
This article appears in the February 2025 issue of Business Alabama.
