The onset of the Covid-19 pandemic in 2020 changed telehealth access in the U.S. and around the world. While the pandemic caused innumerable problems for businesses and industries, telehealth treatment modalities during the public health emergency saw high levels of growth in the U.S. Not everyone can get telehealth access, however, and even as the pandemic recedes, telehealth disparities are many. Many folks who use telehealth over the last year were already using traditional health care modalities and switched to telehealth because they could. There has not been enough outreach to bring more people into the market.
The Digital Divide and Related Concerns
While telehealth has made it easier for some patients to get needed care, especially for people who need help to reach in-person services, it also made the digital divide larger for others. Many patients do not have computers or smartphones or lack broadband access. A related challenge is a lack of digital literacy, which refers to how well a given person is acquainted with a given technology. If a person doesn’t know how to use a cellphone for telehealth sessions, for example, the phone is worthless as a means of accessing telehealthcare. Further, Robert Wood Johnson Foundation and Health Affairs national reports show that technology hasn’t reached new patients and that those with limited English language skills had lower rates of telehealth use.
Telehealth and Health Disparities – Getting Past Two-Way Video Consultations
As already mentioned, millions of Americans don’t have access to high-speed internet. Additionally, many low-income people live in multigenerational households or even shelters and therefore don’t have the privacy needed to meet with a physician over live video. For these reasons, the concept of telehealth needs to be broadened beyond just two-way video visits to meet the needs of these underserved communities.
Moving to audio-only consultations can help provide a more integrated, private experience for low-income folks. Patients without privacy in their homes can conduct these visits from a cell phone from their cars, from a park while taking a walk, or in another space where they feel safe discussing their health care. Additionally, the use of asynchronous forms of communication, including mobile messaging, enables privacy and discretion. Mobile phone messaging is also highly accessible, with by far most Americans owning a smartphone that allows them to reach their clinicians through secure, mobile-friendly web portals.
To this end, lawmakers need to adjust reimbursement policies to support different modes of telemedicine, which can encourage the adoption of these additional telehealth communication channels, resulting in a patient-centered experience that considers the realities of patients’ lives. On March 25, 2021, Congress introduced the Ensuring Parity in M.A. and PACE for Audio-Only Telehealth Act, allowing reimbursement for audio-only visits for Medicare Advantage patients, which is a positive step if the bill becomes law.
Telehealth and Health Equity – Connecting Patients to Social Services
Most people associate health care with seeing a doctor for preventive care or to address a particular issue. Yet many facets of a person’s life are a part of that person’s wellness, including hygiene, access to enough food, and career training. Telehealth providers can help refer people to these resources and more, becoming a sort of hub with each social factor as a spoke in a wheel. They also can offer psychoeducation or even telehealth interpretive services as part of their licensed telehealth services. If the telehealth company offers such a platform, they can receive referrals from these organizations making a truly integrative and supportive network.
Protecting Rural Telehealth Access Act
A number of bills are being introduced to address telehealth and health disparities. For example, on June 9, U.S. Senators Joe Manchin (D-WV), Joni Ernst (R-IA), Jeanne Shaheen (D-NH), and Jerry Moran (R-KS) introduced the bipartisan Protecting Rural Telehealth Access Act to make current telehealth flexibilities permanent. If passed, this legislation would allow rural and underserved community healthcare providers to continue offering telehealth services after the public health emergency. Services addressed by this bill include the ability to offer audio-only telehealth (telephone telehealth) appointments. This issue is considered one of helping to deal with telehealth disparities because many rural Americans do not have affordable and reliable broadband access. Many don’t even have computer equipment or the technology literacy to know how to use the computer equipment available. See Digital Health Literacy and Related Access to Care
Also of relevance to the Protecting Rural Telehealth Access Act are two recent TBHI articles about reimbursement, telephone telehealth is controversial, and bills to support reimbursement for telephone telehealth have been introduced. See Controversy about Eliminating Telephone Telehealth Coverage and Telephone Telehealth Safety Procedures for Professionals.
Telemedicine and Telehealth Disparities – Keeping Telehealth Affordable for All
No health platform is any good to a patient that can’t afford to be part of it, and that includes telehealth providers, which can take steps to ensure services are affordable to underserved populations.
One of the more significant steps that telehealth organizations can take is to accept Medicaid patients. Thanks to first the Affordable Care Act and second the pandemic, there has been tremendous growth of people signing up for Medicaid – especially over the last year. Further, millions of individuals lost employer-sponsored insurance in 2020, and almost all of those folks are eligible for either Medicaid or subsidies under the Affordable Care Act. There are indications that Medicaid adoption will only continue to increase, with Alabama and Wyoming recently considering Medicaid expansions.
Another crucial part of making telemedicine affordable is to help patients navigate their insurance; this should be an integral part of their telehealth experience. For example, many insurance companies cover branded and generic versions of the same medication differently, and many Americans report difficulty affording the cost of their prescription medicine. If telehealth organizations communicate to patients that they will offer services to help them find a free or low-copay drug option, patients may be more likely to sign up for a telehealth visit and fill their prescriptions, which would, in turn, improve their medication adherence.
Lastly, using different modes of telemedicine can be used to make ongoing care more cost-effective. For example, women often stop using contraception when family planning counseling may help them stay on it by addressing their questions about side effects. Telehealth providers can use asynchronous messaging, which is not a great fit for counseling but can be employed by providers in cases like this to follow up with patients seamlessly, answer questions promptly, and help patients find treatments to which they can adhere.
PLEASE NOTE: the Telebehavioral Health Institute (TBHI) has recently been rebranded and is now known as Telehealth.org
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