Can Telemedicine Solve the Rural Healthcare Crisis?

Intermountain Health’s new high-powered collaboration aims to create a network of connected hospitals, sharing services and providers and reducing transfers. Could this be the model to solve access and care barriers?

The key to rural health access may very well be telemedicine. And a coalition launched by Intermountain Health may be the model for that strategy.

The Salt Lake City-based health system, which has a footprint in several rural states, is joining forces with Microsoft, Epic, Gates Ventures and West Health to develop a hub-and-spoke telemedicine platform aimed at connecting small critical-access and large hospitals in a network that facilitates virtual care and reduces transfers and travel.

Dan Liljenquist, Intermountain’s Chief Strategy Officer, says the partnership, unveiled last December but in planning for a while, aims to address healthcare disparities and access issues across rural America. Roughly 60 million people, or 20% of the nation’s population, are struggling to find the care they need, while 20% of the county’s rural population live in counties without any hospitals.

And those problems are growing. At least 25 hospitals closed in 2024, and more than 700 rural hospitals—about a third of all rural hospitals in the U.S.—are in danger of shutting their doors.

“What you’re starting to see is a significant disparity in how healthcare is delivered,” he says. “Cancer mortality rates are 2% in urban communities and 15% in rural communities. Why? Because it takes forever to go get care, and people are choosing just not to get care because it’s a three-hour drive and there’s nothing they can do. Or you have a stroke and you’re three hours away. So you have sick people driving by a critical access hospital trying to get to a big city where the specialists are.”

Intermountain’s strategy isn’t entirely new. The health system has long been recognized for its telemedicine and digital health programs and strategies. But Liljequist notes many of those programs have existed in their own silos, serving certain populations or hospitals; whereas this effort aims at an enterprise-wide platform that connects not only hospitals and other sites within Intermountain, but outside the network as well.

“What if we systemize all of this and create what we call a virtual hospital?” he asks.

The effort started, he says, with a plan to lay down a telemedicine infrastructure to stabilize small, rural, critical-access hospitals, giving them on-demand access to clinicians to help them treat more of their patients rather than sending them on costly and risky transfers to larger hospitals. That network now serves roughly 33 hospitals within Intermountain as well as about 40 outside the health system who contract for telemedicine access.

Liljenquist says the cost to those small hospitals is small, but the service helps them to keep an extra 13% to 18% of their patients. This not only reduces transfer costs but allows the hospital to capture charges and improve care management.

“That’s a big, big deal, and it’s a big deal for patients because they don’t have to travel,” he says. “It’s a big deal for the community because we’re able to bring real-time expertise to the bedside. You oftentimes don’t need immediate surgical care. It’s ‘I need somebody with hands on the ground to do this or that [while being] coached by another doctor who’s a specialist.’”

Liljenquist envisions critical-care access hospitals using this platform to access on-demand specialists from Intermountain, enabling on-site staff to care for patients who would otherwise be transferred to a larger facility. This, in turn, improves the hospital’s census, stabilizing finances and keeping patients in their community, closer to home.

“You're paid on a DRG or on a code based on the complexity of the case and the more complex you can handle locally, the better your reimbursement is,” he notes.

This is especially important, he says, in light of the growing senior population, which will demand care closer to home (not to mention the roughly one-quarter of Intermountain’s doctors and nurses that are Baby Boomers themselves).

Collaboration with key technology and healthcare organizations is important, Liljenquist says, because Intermountain can’t do this alone. A telemedicine platform spanning not only hospitals but health systems needs good digital health tools and a strong EHR to coordinate data storage, analysis and exchange, hence the participation of both Epic and Microsoft.

“The biggest challenge is that our doctors sometimes have 15 different logins to 15 different EHRs to try to do that,” he says.

And with this strategy taking aim not only at the growing senior population but access and equity issues affecting rural communities, both the Gates Foundation and West Health are on board.

“It's not just consolidating programs, systematizing what we do, agreeing on all the technology, but really mapping and making sure that that when we go out and offer these services that we're offering them consistently,” he says.

Liljenquist sees this platform as a model that could be embraced by other large health systems, creating hub-and-spoke telemedicine networks across the country.

“What can we share and what we're hoping is, is that there's interest from other folks who say, ‘Oh, we might be able to do something similar,’” he says. “We might be able to learn. We might be able to create really a unique overlay that helps stabilize rural healthcare nationwide. That's what we're interested in figuring out.”