A fast-growing Central Iowa telehealth company developed by a Drake University graduate has become an important partner and care multiplier for safety-net clinics and health care organizations across Iowa and a growing list of states across the country. 

Ben Lefever launched Certintell six years ago with two employees and two interns, becoming the first tenant of the Square One Accelerator in West Des Moines. Certintell, now based in downtown Des Moines, offers a virtual medical practice platform that works with federally qualified health centers (FQHCs) and other clinics that have large populations of Medicaid and Medicare patients, particularly those serving rural areas. FQHCs are Medicare-certified safety net providers that primarily provide services typically furnished in an outpatient clinic. 

“We focus on organizations that provide care to underserved communities; we have a mission to serve patients that essentially look like me,” Lefever said. “We’re here to help [them] improve the health outcomes, lower the cost of care for the high-risk patient population that they don’t have enough time to spend with. We let them know that we’re not there to steal their patients; we’re there to be an integrated part of their care delivery.”  

In Iowa, Certintell works with multiple behavioral health practices, “and through a great relationship with the Iowa Primary Care Association, we are looking to implement remote patient monitoring with all 14 of the Iowa FQHCs” as their patients have been hit hard with COVID-19, Lefever said. 

Telehealth is an exceptionally crowded field in U.S. health care, but also a market poised for enormous growth. The industry journal Becker’s Hospital Review recently listed more than 260 telehealth companies that it’s aware of in the United States (Certintell wasn’t on that September list). Becker’s cited a report by technology consultant Frost & Sullivan showing the telehealth market in the United States is estimated to grow sevenfold by 2025, resulting in a five-year compound annual growth rate of 38.2%. Due to the pandemic, the telehealth market this year is expected to increase 64.3% over 2019. 

Using its technology platform to connect with patients’ computers or connected devices at clinics, long-term care centers or in their homes, Certintell’s clinical health coaches work with patients to meet their goals in controlling chronic conditions, including behavioral health issues. “We don’t see patients in a brick-and-mortar location; we engage them where they are,” Lefever said. “Our clinical staff and team [of nurse practitioners] are also remote.” 

One of Certintell’s early partners was the Louisiana Primary Care Association. “They have been ravaged by COVID and the hurricanes, but they saw the vision that we had, and partnered with us early on,” Lefever said. “As a result, we’re quickly getting thousands of patients on our remote patient monitoring connected device program, and others are starting to follow suit.” 

The company now has client clinics and health systems in 25 states, with a mission of “helping to close the care gap.” 

“It’s really just providing access to improved health outcomes for folks that in many ways are disenfranchised with the health care system, and so don’t seek out care when it’s needed,” Lefever said. “So how can we partner with them to make sure these patients get the care they deserve?” 

Certintell now has a four-person medical staff that supports six certified clinical health coaches. Lefever anticipates adding 20 more clinical health coaches within the next year. Those health coaches receive training through a certification program operated by the Iowa Chronic Care Consortium. 

Certintell has been able to demonstrate the benefits of better patient engagement through improvements in patient health outcomes, he said. 

“We had one of the early pilot programs with safety-net clinics in North Carolina, and through that we’ve been able to show significant decreases in A1C levels [a measure of blood sugar levels] for patients; there’s been a tremendous impact around that. We’ve been able to show quality improvement measures around patient engagement. That’s an important component of what [insurance company] payers want — how engaged are your patients?”  

The coronavirus pandemic was not on the horizon when Lefever launched the company, “but it certainly highlighted the disparities,” he said. “We’re excited to really deliver our mission to support these patients that are sometimes lost in the shuffle.” 

A native of Indiana who grew up in a foster home, Lefever came to Des Moines to attend Drake, where he ran track and double-majored in journalism and economics. Starting out his career in pharmaceutical sales with Eli Lilly Co., he became involved in a special project to expand Lilly’s program for connecting medical specialists with hepatitis C patients in rural and underserved areas. 

“That was really my first experience with telehealth,” he said. “For me, it was eye-opening, because the patients that were afflicted with this disease, a lot of them had to deal with socioeconomic status challenges of transportation in getting to specialists and the like.” 

Later, while working for Genentech, he collaborated with University of Iowa Hospitals in hepatitis C screening using a model he had developed to connect patients in underserved areas of the state with liver specialists. 

In Iowa, one of Certintell’s partners is Broadlawns Medical Center in Des Moines, which has six licenses with Certintell for clinic providers to see patients virtually using its technology platform. The majority of virtual visits are with outpatient behavioral health patients, but a number of different specialists, from neurology and family health to sleep center specialists and geriatricians, connect with patients using the technology. 

Dr. Yogesh Shah, chief medical officer and vice president of medical affairs at Broadlawns, said that Dr. Robert Bender, who like Shah is also a geriatrician, had worked with Lefever and Certintell while he was still in private practice. Bender continued to use Certintell after he joined Broadlawns and so many of the hospital’s clinics also began using the system. The current pandemic has accelerated usage of telehealth this year, Shah said. 

“Telehealth has grown almost 200% or higher because of COVID,” he said. Counting both videoconference and telephone-only visits, Broadlawns providers handled 1,000 patient visits virtually between Nov. 1 and Nov. 9. Of those visits, 156 were telehealth with video, the majority of those being outpatient behavioral health-related. 

“That’s a significant number, and it’s a significant number for good care,” Shah said. “Otherwise they would have had to go to urgent care or the ER. So it’s reducing unnecessary visits, keeping quality high and costs down.” The number of no-shows among behavioral health patients using telehealth appointments decreased by about half, he said. 

Lefever said that Certintell has significant growth plans in a number of states. Among its growth prospects, Certintell is now scaling up its telehealth program with a Utah health system that has nearly 10,000 patients who could potentially be served, along with an Indiana clinic system that has close to 30,000 patients. 

“Our aspirations are really, really big, but focused on the patients who feel disenfranchised by the system,” Lefever said. “We want to create an ecosystem that really supports any patient’s needs.” 

 

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Iowa Chronic Care Consortium training 43 community health ‘navigators’

In October, the Iowa Chronic Care Consortium received $94,512 in funding from Iowa Workforce Development’s Coronavirus Relief Employer Innovation Fund to provide training to 25 individuals as community health navigators. Dr. Bill Appelgate, ICCC’s executive director and CEO, said his organization had such an overwhelming response from applicants that it decided to train 43 individuals. 

The training curriculum will focus on workforce development resources; fundamentals of community health advancement; effective communication skills; health care, social service and community resource referral; personal resilience and self-care; and COVID-19 community response and recovery skills and strategies. The training program will be offered from early November 2020 through January 2021. 

 

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Iowa consortium provides certification for Certintell’s health coaches

Certintell’s clinical health coaches are trained through a certification program offered by the Iowa Chronic Care Consortium, a West Des Moines-based public-private health training consortium.

Originally coordinated in 2003 by Des Moines University, the ICCC was initially launched as a statewide demonstration project to show the effectiveness of using telemonitoring to help patients monitor chronic conditions — diabetes and congestive heart failure. The consortium has grown substantially and has been recognized nationally by the Urban Institute as one of the leading population health programs in the United States. 

About six years ago, the ICCC recognized the need for community health coaches and began a training program to certify health professionals to perform those services, said its executive director and CEO, Dr. Bill Appelgate. The consortium has trained approximately 5,000 health coaches in 45 states since 2014, and has also trained health workers from other countries, such as Qatar. 

“While we’ve trained mostly health professionals working in clinics and practices, we’ve had an increasing number of organizations like Certintell approach us,” Appelgate said. “Certintell has a number of people going through our health coach and our community health worker training.” Certintell also has four employees who were selected to be part of a Community Health Navigator training program recently. 

Both in Iowa and nationally, there is “much more need than there is delivery” in supporting health outcomes through services such as health coaches, Appelgate said. Certintell’s work in partnering with community health centers is a valuable service, he said. 

“Community health centers are the absolute heroes of health care delivery in this country,” Appelgate said. “They have their heads and hearts in the right place. As a class of providers, they’re what the world has been waiting for. … They take care of people that are hard to take care of in a lot of places, yet they do it [with] aplomb. We’re fortunate to have a great community health system in Iowa” through the Iowa Primary Care Association’s member clinics. 

Certintell has taken the extra step of having some of its health coaches who had received training return to also complete the community health worker course, which specifically focuses on connecting with community resources, Appelgate said. “They’re saying they want [their health coaches] to understand the factors, such as food insecurity, that are affecting them,” he said. 

“The concept behind Certintell is very smart,” Appelgate said. “They have a very logical approach; that’s why we like working with them. The question is: Can they really make it fly from an enterprise perspective?”