How to prevent telehealth from exacerbating health disparities

Telehealth offers new options for delivering care, but organizations will need to work together to ensure that it doesn’t create a deeper care divide.

The use of telehealth services significantly increased because of the COVID-19 pandemic. And with the continued focus on providing digital solutions in almost every industry, this new modality is here to stay.

When implemented with a patient-centric approach, the use of telehealth services – such as virtual care visits, online chat communications with providers and remote patient monitoring – can help improve access to quality healthcare and close health equity gaps. However, if not designed with intention to accommodate individuals’ preferences and needs, telehealth has the potential to exacerbate health disparities.

Recently, the National Committee for Quality Assurance published a white paper, which stemmed from a roundtable discussion on the future of virtual healthcare delivery in a post-pandemic world. Panelists included experts in telehealth, technology, regulation and policy from MedStar Health, Veterans Affairs Medical Center and the National Partnership for Women and Families, among others. These participants used a hypothetical, patient case-based approach to identify both technical and structural issues that lead to inequities in telehealth and recommended concrete solutions for overcoming them.

Obstacles that can worsen the digital divide

One of the key issues identified was the lack of universal broadband access. Some estimate that at least 18 million and perhaps more than 42 million Americans – still lack access to a reliable high-speed internet connection.

In addition, organizations cannot assume everyone has access to a private and safe space that would allow them to virtually meet with a healthcare provider. Further, digital literacy levels can vary among individuals based on such factors as age, race, ethnicity, upbringing and socioeconomic status. And some people may not feel comfortable using technology for healthcare.

Roundtable participants discussed how outdated federal regulations can act as barriers to leveraging telehealth and other tools to communicate with underserved populations during critical times, such as a public health emergency. There is a need to carefully examine rules and regulations under HIPAA and the Telephone Consumer Protection Act of 1991 to determine how they can be updated to promote equitable access to telehealth and other tools while still protecting patient privacy.

Restrictive payment and coverage policies can present additional challenges for those seeking to utilize telehealth services.

Roundtable participants noted that reimbursing telehealth visits at the same rate as in-person visits is essential to maximizing the benefits. As of March 2022, only six states had laws governing private payer payment parity for telehealth services, according to the Federation of State Medical Boards.

Additionally, while telehealth is supposed to broaden the reach of healthcare services, states’ physician licensure laws can prevent providers from practicing in multiple states. This can be especially limiting given the current clinician shortage.

Optimizing state licensure laws to allow physicians to practice via telehealth in multiple states would not only increase access to care but would also facilitate patient-centered care by providing people with a larger selection of doctors so they can work with a physician who’s a good fit.

Improving telehealth quality and equity

To address barriers, roundtable panelists proposed a combination of patient-centric, policy-focused and technology-based solutions, including:

  • Tailor telehealth use and access to individual preferences and needs. A focus on patient-centricity will be at the core of ensuring equitable telehealth. Virtual care must be tailored to the individual. Providers should prioritize a patient’s language and cultural preferences and use telehealth platforms that incorporate translator services. Telehealth product designers will need to develop quality digital tools for those with visual, cognitive, sensory or other disabilities.
  • Address regulatory, policy and infrastructure barriers to fair telehealth access. Providing reliable, high-speed internet connections will be a necessity so that everyone has access to telehealth services. While broadband access should be improved through investments proposed by legislation, public/private partnerships should also be promoted to help address these issues. In addition, policies that stymie the expansion or continuation of telehealth, limit medical licensure to certain states and prohibit or limit reimbursement of telehealth services should be revised.
  • Leverage digital technologies to promote equitable care delivery. While it may seem like the best approach is to use the most up-to-date technologies when implementing telehealth, this does not consider challenges stemming from limited access to these tools and varying levels of digital literacy. Developing and using technologies with low barriers to entry – ones that are simple and inclusive – can empower individuals to participate in telehealth services. It will be crucial to get design feedback from patients and providers throughout the product lifecycle so that tools can be improved. In addition, both healthcare professionals and patients will require continuous training on how to use new digital tools and devices.

Realizing the full potential

While telehealth cannot be used effectively for every healthcare service and will not completely replace in-person care, this modality presents an opportunity to help close equity gaps.

Healthcare providers and systems, insurance plans, technology developers and design teams will need to work together to help realize the full potential of telehealth and promote equitable access to healthcare.

Theresa Hwee, MPH, is senior healthcare analyst for the National Committee for Quality Assurance (NCQA).

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