Telehealth opens doors to treatment in North Idaho

Angela Jepson has tried several drug treatment programs over the years, but recently, she’s found something that’s working.

She gets treatment at Ideal Option, a provider with clinics all over North Idaho. She’s been going for about a year, consistently for the last six months, and has been able to get treatment seeing her doctor either in-person or via telehealth.

Jepson has struggled with opioid addiction for about 18 years, and suboxone, a drug that helps curb her cravings, allows her to live her life more freely and healthily.

Ideal Option offers medication-assisted treatment for addiction to opioids as well as treatment for addiction to other substances, including alcohol.

Recently, Ideal Option was awarded some state funding to expand its services, opening clinics in Kellogg and Sandpoint.

This expansion was made possible, in part, due to the changed regulations around telemedicine in Idaho.

Before the pandemic, Dr. Richard Mattis had to see patients in-person during their first visit to an Ideal Option clinic, because state law mandated it to establish a relationship between a provider and patient.

When the pandemic hit, the governor and the Idaho Department of Health and Welfare changed the telehealth law to more easily accommodate patients without putting their health at risk.

Mattis took on many new patients via telehealth, establishing relationships with new patients seeking treatment who walked through the door – even if he could only see them via video screen.

Telehealth for substance use treatment has opened up options for people in rural parts of North Idaho and even western Montana, Mattis said.

“You can’t do substance-use treatment full scale in Idaho without telemedicine,” he said. “If you don’t have telemedicine, you have to have a provider at every clinic all the time.”

Ideal Option recently opened new treatment clinics in Sandpoint and Kellogg. Mattis said this expansion is only possible with the altered telemedicine rules.

He can’t get up to those clinics every day and wouldn’t go just to see one or two patients, especially when he can now see patients at several clinics, each day. Those more rural treatment clinics will still have staff: a medical assistant and another assistant to check people in and take their urine analysis or other tests as a part of their treatment. Then they can see the doctor via video.

Patients who previously had to drive from outside Kootenai County or even Montana to Coeur d’Alene to see a doctor to start treatment at Ideal Option can now go to clinics closer to them.

Mattis said he took in two walk-in patients, despite having a full schedule, on a day in mid-December. Telemedicine enables him and other providers offering similar treatment to do what they know works best in addiction treatment: offer services when a person seeks them out.

“The biggest thing with these patients is you have to meet them right here, right now, and when they say they’re ready, we have to be ready right now – not in two weeks,” Mattis said.

The Idaho Department of Health and Welfare also tweaked the telemedicine law to allow providers to be prescribers once they’ve established a patient relationship via telehealth.

This is the key to medication-assisted treatment, which is evidence-based addiction treatment especially for opioid addiction. Mattis said he is seeing a lot of patients addicted to fentanyl and heroin, which are both opioids.

Drugs like suboxone can curb a person’s cravings. Treatment is also preferable to the alternative, which can lead to overdosing.

In 2019, 134 opioid-related deaths were reported in Idaho. In 2020, there were more: 164.

The Idaho Department of Health and Welfare plans to keep most of the changes they made to telehealth access in Idaho into perpetuity, said David Bell, deputy administrator for policy and innovation at Idaho Medicaid.

Bell said the expansion of telehealth due to the pandemic has been “a real good thing.”

“As our director likes to say: We gained about 10 years worth of work in about six weeks and it was intense, but we got it where people can get the services they need,” Bell said.

Idaho is a very rural state, and increasing health care access, even virtually, is a win, he said.

Nearly all of Idaho is considered a health professional shortage area, and rural counties experience higher uninsured rates and poverty rates than urban counties. In North Idaho, four of the five counties are considered rural by this definition.

“We’re short on providers all across the board, so the more we can have providers delivering health care the better off Idahoans are,” Bell said.

When the pandemic hit in early 2020, telehealth access to care skyrocketed in Idaho, data from the department show, and then it petered out as the pandemic wore on.

In April 2020, there were more than 90,000 telehealth Medicaid claims recorded by the department. That number has declined slowly as the pandemic progresses, but even as of November 2021, just under 20,000 Medicaid telehealth claims were processed.

“Anecdotally, we’ve heard from providers that their cancellation and skip rates are way down because there’s not a barrier of going to the office physically,” Bell said.

For rural North Idaho, the change in state policy will hopefully, patients and providers say, continue to expand services to people who need them.

For clients like Jepson, having access to a doctor when she needs one is vital.

The providers at Ideal Option were flexible and open to her coming back sooner than she was scheduled if she needed to or felt like she wanted to talk to her doctor sooner.

“That’s what made me stick with it,” Jepson said.

Every three weeks she goes to the clinic, takes a urine analysis test and talks to a provider either in-person or on a video screen before getting her suboxone prescription. She has a solid support system around her, including a Celebrate Recovery group, which she says has helped her remain stable and consistent with treatment.

She said she hopes others like herself can get treatment and know there’s help out there.

For Mattis, substance-use treatment is more than just prescribing medication or seeing a patient virtually.

“We tell every one of them: Your prescription is something in the bottle, but you can come in and see us if you feel like you’re going to relapse. Come in and walk in,” he said. “I want to see you right away.”