The COVID-19 pandemic precipitated widespread implementation of telehealth throughout the United States. As the use of telehealth expands, providers and policymakers are working to understand when and how this technology improves health outcomes and increases health equity for patients. In recognition of the potential of telehealth for improving health equity, St. David’s Foundation has funded a series of research projects aimed at exploring the relationship between quality and access in telehealth services – for both behavioral and primary health care – when used to provide health care services to the uninsured.
This white paper summarizes findings from the literature on telehealth use in Federally Qualified Health Centers (FQHCs) and in other underserved populations. It also includes perspectives from employees at two Central Texas FQHCs, Community Health Centers of South Central Texas, (CHCSCT) and Lone Star Circle of Care (LSCC), on the potential of telehealth to improve health outcomes and increase healthy equity across the health care system. The next phase of the project will explore patient perspectives, specifically focusing on patients with Type II diabetes and depression.
Telehealth has expanded access for many patients by making it easier, less time-intensive, and more comfortable for them to receive health care. The biggest opportunities for improvement in health outcomes, and thus value creation, with telehealth seem to be in the areas of chronic disease management, particularly if paired with remote monitoring, and mental health care. However, disparities in internet access, smartphone ownership, and language interpretation services present major challenges to ensuring that telehealth services contribute to reducing health inequities.
The Power of Relationships
Telehealth needs to support relationships. One study focused on health equity found that continuing to offer in-person visits alongside telehealth services was key to building and maintaining trust with patients. The leaders we interviewed at CHCSCT and LSCC echoed this idea, explaining that they never closed their clinics to in-person visits during the pandemic and believed this was an important signal to patients that they could continue to count on the FQHCs.
Barriers to Telehealth Access & Care
The American Medical Association’s 2021 survey of physicians found that lack of insurance coverage and either low or no payer reimbursement were the most commonly identified barriers to implementing and continuing telehealth services. From respondents’ perspectives, the top three barriers facing their patients were technology, digital literacy, and broadband internet access.