Five years, Five States, and 31,000 visits: Specialty Clinic’s IHS Success Story 

Do you remember what you were doing back in 2016 — a year when the musical “Hamilton” took the country by storm and the Cubs finally won that elusive World Series title? Well, for the Specialty Clinic team at eCare, it was embarking on a new partnership with a federal agency to deliver telemedicine care across the west to thousands of patients. This grant-funded effort was sponsored by the Indian Health Service – a federal agency under the Department of Health and Human Services – and provided the catalyst for launching the Specialty Clinic service line. Midway through, another contract was finalized, and the team started serving patients in Montana and Wyoming as well. How did this 5-year contract turn out? What were the patient outcomes? Well, we sat down with our colleagues Dr. Janell Simpkins and Rachel Dybvig to find out.


What opportunities did this new contract with IHS present?

Dr. Simpkins: 
We were founded to bring health care to rural communities. This has been shown to save more lives, reduce costs, and stabilize the local workforce. Considering 54% of the American Indian population live in rural areas, the IHS contract represented an opportunity to amplify our services and act on our mission of delivering high quality care when and where it’s needed, regardless of where the patients live. Additionally, since American Indians have a life expectancy that is 5.5 years less than the average, this opportunity has allowed us to make real strides in addressing health disparities for this population.  

(Information sourced from  

What were some hurdles the team experienced when first launching the services with IHS?

One persistent hurdle – that the whole health care sector is now experiencing – was the issue of workforce. These rural IHS sites experienced nearly constant turnover, and it was difficult for our Specialty Clinic teams to build up the initial relationships that are so key to our overall success. But, through patience, persistence, and a solid onboarding / training procedure, we were able to overcome this obstacle and build long-lasting partnerships. 

Dr. Simpkins:
I would also add to this point. Yes, the facilities struggled with workforce instability, but those who were most impacted included the patients who didn’t know who was going to deliver their care. We might not realize it here in Sioux Falls, but out in the rural areas we serve, these men, women, and children do not always assume that they will always have access to the care they need, a notion that is heartbreaking. This must change, and it has been so rewarding to serve these patients for the last five years and start to change their expectations. Ultimately, the true benefit of what we do is the relationships we form as telemedicine providers – it’s what enables us to deliver the state-of-the-art care we have become known for across the country. 

Managing a contract of this size must have been a real team effort. What were some success stories that marked our five years with IHS? 

Dr. Simpkins:

Speaking from a clinical perspective, there is one example that immediately stands out. Early in the contract, we discovered that scarring acne was a problem with American Indian patients. The good news is that Accutane provided by dermatologists is a highly effective treatment, one that requires multiple visits, coordination of labs, and intensive monitoring. The challenge was many patients did not have the time or resources to come in for regular appointments. Noticing this issue, one of our Avel dermatologists got down to work and pioneered a virtual treatment – one of the first processes of its kind in the country – to help treat scarring acne. This is a remarkable example of creative problem solving through telemedicine and is only one of many I could highlight when looking back at the past five years. Others include life-saving endocrinology work, treating COVID patients in-home, and administering drug regimens for those struggling with rheumatoid arthritis.  

Dr. Simpkin raises such a good point about patient outcomes. Not only were we able to empower local care teams to deliver exceptional bedside care, but we also delivered the administrative support and expertise to remove additional barriers to care. For example, when these patients invested the time and resources to come in for appointments, we worked with the clinic to maximize their time and schedule future visits. By scheduling right at the sites and setting up reminders with the patients when they were in-person, we were able to eliminate confusion and reduce no-show rates.


What is one key takeaway as you look back on this five-year contract?  

Dr. Simpkins:
Well, my key takeaway from the past five years is that telemedicine can make a real difference for communities that lack stable and accessible health care. In an atmosphere – especially in the virtual health space – where innovation is occurring at the speed of light and change is a constant, I am proud of our team for putting the sweat equity and hard work to build relationships and create lasting partnerships with our IHS sites. It was a classic “turtle beats the hare” scenario, and our approach had the intended effect: we established our credibility with more than 20 sites spread across five states, allowing us conduct more than 31,000 visits and transform the delivery of care to American Indian patients. Avel is now the stable healthcare provider / presence to these men, women, and children, and we are actively ameliorating barriers to care and helping to restore health equity in the process. 

Ditto, Dr. Simpkins! I would also add that I was so impressed by the level of teamwork and collaboration that was required to successfully execute the contract and serve thousands of patients. As you can expect, any work with the federal government requires a significant amount of tracking, documentation, and reporting, and our Specialty Clinic colleagues tackled this assignment with determination. We powered through the administrative tasks and worked hard to ensure our physicians, nurses, and other clinicians could deliver exceptional support to the sites. It was a fantastic example of what makes Avel so special: clinical and administrative teams working together to deliver high-quality telemedicine care when and where it’s needed. 

Number of scheduled clinic visits: 31,000 
Specialties represented: 15 
Number of sites served: 21 
Nebraska, North Dakota, South Dakota, Montana, and Wyoming