Maintaining telehealth access is key to advancing health equity

The COVID-19 pandemic derailed much of America’s access to safe, affordable and efficient in-person health care. Telehealth, which wasn’t widely available or accessible to many Americans before the pandemic, soon filled the gaps, improving access to health care services for millions of people without requiring them to leave their homes. 

With the value of telehealth now demonstrated, it is important that it be permanently integrated into our health care systems as an option for patients and health care providers and that barriers to its usage, such as the need for broadband or video/smart technology, be addressed to assure full access by all patients where they are.   

While telehealth existed prior to the pandemic, it was only a limited offering that needed to be expanded during the pandemic in order to work, such as by covering audio-only telephone visits. Many states eliminated the requirement that services must be administered by a licensed in-state provider. Medicare waived its requirement that telehealth was only covered for rural patients and only if obtained at certain health care sites. Further, it added dozens of services to the list of covered telehealth care, allowed more providers to be covered and enabled more services to be administered at home, in residential facilities or at other locations at a reimbursement rate comparable to in-person ones.

Actions like these contributed to a surge in telehealth usage: More than 28 million Medicare beneficiaries used telehealth in the pandemic’s first year, and they used 88 times more telehealth services compared to the year before the pandemic. Telehealth usage continues to remain above pre-pandemic levels — especially for mental health and substance use disorder treatment — showing there is an ongoing need for systems that support remote health care.

But despite this increased availability and usage, there are barriers to telehealth — such as access to broadband and end-user devices for people without smartphones and video options — that must be addressed in order to reach underserved populations. Patients who do not have the digital infrastructure to access telehealth (computers at home, broadband internet, digital literacy, etc.) are excluded from health care services that require video capabilities. This disparity particularly impacts the poor, as well as those in rural areas and urban deserts, fueling further inequities in our health system. That’s why any push for continued and expanded telehealth services must go hand-in-hand with efforts to strengthen digital infrastructure and education.

It is also important that the usage of telehealth is an option for the patient and their health care provider and does not necessarily replace in-person appointments where desired. Flexibility must be maintained as we learn the value and cost-benefit of telehealth and incorporate what works into health practices. Coverage should not jeopardize access to health care that meets patients where they are when they need it. Telehealth has been a lifeline for many Americans who don’t live near a doctor’s office or health clinic, don’t have access to reliable transportation, are living with chronic health conditions, cannot afford in-person care costs and must juggle work and care responsibilities and can’t afford to take time off for appointments.

The long-term benefits around access to telehealth services are clear, making it incumbent that affordable quality telehealth coverage is made a permanent option, especially for patients and providers that need it. This will ensure that patients receive the care they need when and where they need it and that providers receive adequate support and reimbursement for telehealth service delivery. 

Thankfully, in the recently passed FY2022 omnibus budget bill, Congress provided an extension of Medicare telehealth flexibilities for five months after the public health emergency ends and further directed that telehealth expansion be studied. The Centers for Medicare and Medicaid Services also issued a proposal that would extend coverage (as allowed during the pandemic) until the end of 2023 to allow for research on the expansion of telehealth and various services added during the pandemic. This will help determine how to design a more permanent program offering, leaving open what services and conditions will be a part of coverage. 

While important considerations remain around what telehealth expansion looks like at the state and federal level, how much it will cost and how to ensure that patients receive quality care, the case for permanent telehealth care is compelling. Making telehealth a cornerstone of our public health infrastructure will enable millions of Americans to get affordable, efficient and safe health care at any time and any place.

Martha Nolan is a senior policy advisor at HealthyWomen.

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