Reducing Barriers Related to Telehealth Utilization

Melissa Fox, MHA, FACMPE, FACHE

Telehealth as a method of service delivery has risen in utilization over the past year. However, since this care option is not easily accessible by all, health care providers should plan to incorporate strategies which help ensure underserved populations get equitable access to virtual care.

Telehealth is by no means a new approach to care, but the exponential rise in usage due to COVID-19 has elevated key discussions related to reimbursement, privacy and most importantly — patient access. Federal and state restrictions related to telemedicine have been adjusted or relaxed in order to support in-home delivery of care and potentially reduce the transmission of the coronavirus. This approach is relatively low-risk and high value since multiple studies have demonstrated that the outcomes for telehealth appointments are comparable to in-person care, and an adequate substitution for face-to-face appointments.

However, while the availability of telehealth has increased significantly, there are many communities which do not have access to the technology needed to successfully complete their care. Whether it is due to a lack of computers, limited availability of broadband or simply a low level of comfort with technology, many people are not able to access care via telehealth – even during a raging pandemic. Unfortunately, these are the communities which also tend to be the most at risk of chronic health disparities or unnecessary hospital admissions due to chronic conditions. A 2017 Kaiser Family Foundation study found that 25% of non-elderly adults with Medicaid did not use the internet and 40% did not use email. Additionally, a Harvard study revealed that 21% of rural Americans reported difficulty with accessing high-speed internet.

Researchers used data from Mount Sinai, a New York City hospital, to further investigate the healthcare gaps exacerbated by the COVID-19 crisis. Of the 40,000 patients studied between March 20, 2020 and May 18, 2020, three main disparities were revealed: race, age, and language preference. Those who identified as White, Asian, or “other/unknown” were more likely to use telehealth services than Black and Hispanic patients. In fact, 60% of Black patients and 48% of Hispanic patients visited the Emergency Department during the height of the pandemic rather than telehealth options. As far as age goes, only 24% of adults over 65 used telehealth compared to the 47% of adults age 30 to 49. Only 25% of Spanish-speaking patients utilized telehealth options.

The data underscores the inequity of access as it relates to telehealth, which means health care organizations must bridge the care gap by incorporating processes to help ensure consistent utilization. The following considerations are recommended as part of any telehealth strategy:

Analyze – Review your current patient data to determine which percentage may be at risk of limited access. This information can be collected by analyzing existing patient demographic data as well as the results of targeted community-based individual surveys. The results can not only help guide the HCO’s telehealth approach, but also help inform future educational outreach programs. By preparing for the level of need prior to implementation, HCO’s can both reduce unnecessary inefficiencies, and help ensure patients receive the care they need.
Affiliate – HCO’s may consider partnering with other organizations to support patient access to necessary hardware as needed (laptops, smartphones, etc.), as well as broadband access. There are federal programs which provide cell phones at no cost to qualifying individuals. Additionally, programs such as the Federal Communications Commission’s Rural Health Care Program can serve as a template to replicate in other underrepresented populations experiencing connectivity issues.
Assess – Continually monitor both telehealth utilization as well as access, and adjust care approaches as needed. This step may involve additional outreach, but may be well worth the effort so vulnerable patients are not unnecessarily at risk.