The path forward: How telehealth continues to provide care for underserved Americans

When COVID-19 hit just two years ago, U.S. health care systems were in for a huge adaptation period. Because of health risks and restrictions, many people could not visit their primary health care physicians in person — their only option was to meet with them virtually via telehealth.

In the recent study The Roadmap to Telehealth Efficacy: Care, Heath, and Digital Equities by Brookings Governance Studies, researchers define telehealth as “the delivery and facilitation of health and health-related services, including medical care, provider and patient education, health information services, and self-care via telecommunications and digital communication technologies.”

In this article, we will explore how the pandemic changed telehealth, why virtual health services are important, and the path the Brookings researchers suggest in order to permanently implement telehealth in the United States.

How COVID-19 changed telehealth

Prior to the COVID-19 outbreak, health care providers (HCPs) reserved remote health care services primarily for patients with common contagious diseases to keep them from infecting others. But when the coronavirus locked down health care facilities across the country, telehealth became the only option for most people to get routine medical care.

How did this shift happen so quickly? State and federal agencies relaxed some of the restrictions that had prevented HCPs from using telehealth. As a result, telehealth proliferated, and during the peak of the pandemic, more than 99% of health care facilities were able to provide virtual health care services in some form. This meant that everyone had access to the care they needed, especially those in medically underserved populations.

Brookings researchers discovered that more vulnerable populations have smartphones and other mobile devices at their disposal than ever before. This further expands access to remote health care, while reducing the expense of transportation to and from a provider’s office.

Why telehealth is important

Telehealth is important for many reasons, one being improved care for all patients. It is categorized as “value-based care,” which means providers are paid based on their patients’ health outcomes and the quality of their care. This model allows more flexibility and helps providers use their resources more efficiently, which ensures comprehensive care for all patients.

It also means that people from diverse backgrounds who struggled to get the right care before COVID-19 now have the opportunity. It bridges the access gap and erodes health disparities that affect vulnerable groups, including people of color and residents in rural areas.

“Telehealth helps underserved communities in a number of ways,” said Chris McGovern, Connected Nation’s Director of Research Development. “It provides access to specialist care to residents in even the most remote, underserved areas. It makes it easier for the elderly, those who are immunocompromised, and those with mobility issues to be treated more safely and easily by their HCP. It reduces the cost of child care, the need to take time off from work, and the commute to and from the doctor’s office.”

In addition to providing vital health services to all patients regardless of geographic location or financial ability, telehealth also helps bridge the Digital Divide. Lack of access to reliable internet is a major issue that many organizations, communities, and federal/state officials are trying to solve. Expanding telehealth and making it the new norm will help bring attention to the issue of connectivity — one that many people might have not given a thought about before.

“If individuals don’t have internet access, they cannot access telehealth services,” said Connected Nation Research Assistant David Nunnally. “If the internet is too slow, certain modalities, like two-way audiovisual telehealth services, become difficult. And without attention to digital literacy, even if individuals have access to reliable internet and devices, they may not know how to use them adequately to access telehealth services.”

Proposed recommendations

In the Brookings study, researchers created a list of recommendations to help physicians, hospitals, urgent care facilities, and primary care providers implement telehealth into their day-to-day operations, allowing more Americans to get the care they need. Recommendations include:
  • Federal and state governments must continue expanding telehealth availability and use in a post-pandemic environment through codifying its use, especially in legislation.
The first thing federal and state agencies must do is make telehealth flexibility guidelines permanent. They can do this by extending the policies already in place from COVID-19. For example, agencies should allow non-rural residents to use telehealth services and CMS (Centers for Medicare and Medicaid Services) offices to permanently expand the list of covered telehealth services and modalities.

“Emergency orders and waivers resulting from the COVID-19 pandemic led state and federal agencies to loosen many of the restrictions that slowed or prevented the expansion of telehealth services, but many of those waivers have already expired or are about to,” said McGovern. “Telehealth expansion should be done judiciously to minimize the risk of fraud and ensure that dollars are spent efficiently.”

Brookings researchers suggest that it is time for Congress to permanently incorporate telehealth into the U.S. health care system to provide more cost- and time-efficient health care for patients.
  • Accommodate new and changing technologies.
The next tactic to overcome telehealth challenges is digital equity — making sure HCPs and patients know how to use rapidly changing technologies. Local health centers can be essential in assessing the online needs of patient populations and helping to train them. Very often, communities don’t know about the resources available to them.

“If individuals cannot properly use digital devices, they will not be able to navigate these new telehealth technologies,” said Nunnally.

It is imperative that these health care facilities create long-term plans to teach patients how to keep up with the changing technologies, if they want to continue using telehealth in the long run. The creation or expansion of community health centers could help solve the issue of digital literacy by combining technology training with other patient education programs.
  • State and localities must prioritize telehealth in their broadband plan and include local stakeholders.
In order for telehealth to continue, patients must have access to high-speed internet. Federal agencies have taken notice of the lack of broadband across the country that has come to light due to COVID-19. They have made closing the Digital Divide a priority by proposing new legislation that includes funding for broadband access.

The Bipartisan Infrastructure Bill is one example. It says that when states build their infrastructure plans, they must work to incorporate telehealth as part of their plans and increase remote health care access for vulnerable populations.

“Many individuals lack reliable or fast internet service, and/or devices to access the internet,” said Nunnally. “National investments like the Affordable Connectivity Program and several other bills being negotiated in Congress provide funding for these endeavors, which make telehealth a reality for individuals who may not have been able to take advantage of the services otherwise.”

The path forward

The COVID-19 outbreak brought telehealth to the forefront, but the Brookings study shows us that the demand for virtual health services is not going away. If anything, the need will continue to grow.

To make sure every American who needs remote health services has access to the right tools and technology, we must work toward creating a telehealth roadmap together, including better broadband for all.

About the Author: Lily McCoy is the Connected Nation Social Media and Communications Specialist. Lily provides support to the Communications Department through social media outreach and writing. She also adds a source of creativity to the team with a background in personal relations and marketing. Lily has a bachelors in corporate and organizational communications from Western Kentucky University. 
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