Expanding Telehealth Coverage to Ensure Health Equity for All

As the COVID-19 pandemic reached its worst in 2020, access to digital health services emerged as a silver lining in a dark cloud. The ability to remotely consult with physicians, nurse practitioners and other clinicians allowed patients to continue their healthcare treatment while avoiding exposure to the virus.

A significant boost came when Medicaid and Medicare expanded coverage to include digital services, often referred to as telehealth. However, that expanded coverage may soon end. If that happens, it will be a serious setback for health equity.

Some lawmakers and healthcare companies are calling for the pandemic changes to be permanent. An act extending telehealth medicine support for Medicare patients to at least 2024 is currently under consideration in the U.S. Congress.

“To ensure continued access to telehealth, Congress should make key pandemic-era telehealth policies permanent,” wrote healthcare provider Kaiser Permanente (a Fair360, formerly DiversityInc Hall of Fame company) on its website. “They should support access to phone-based care while working to expand digital access.”

Achieving true health equity requires taking steps in two key areas. The first is continuing to support the use of telemedicine. The second is ensuring that those in low-income and underserved areas can access the digital tools needed to benefit from digital care.

What Is Telehealth?

Telehealth is not one, specific type of healthcare service. Instead, the term encompasses the wide variety of health services that providers can offer patients by using modern communication channels and advanced medical technology. The goal is to improve access to medical care and education for everyone.

During the height of the pandemic, accessing healthcare remotely proved especially important for older patients who were more at risk of suffering the worst outcomes from the virus. But telehealth continues to provide advantages to many types of patients.

For example, patients from disadvantaged areas may have few transportation options and benefit from speaking with clinicians through video chat or a phone call. The same advantage also applies to those with chronic conditions or illnesses that limit mobility or those who live far from the nearest medical clinic.

Increased Popularity of Telehealth

Telehealth remained a popular choice for patients even as the worst threat from the pandemic receded.  A survey published in late 2022 by the National Center for Health Statistics found that 37% of adults used telehealth services in 2021.

The survey found that women (42%) used telehealth more than men (31.7%) and that telehealth services increased with education.

The decision to expand Medicaid and Medicare coverage to include telehealth also impacted the number of patients using digital health services because of the sheer number of people using each service. Medicaid enrolls about 76 million low-income Americans, according to the U.S. Government Accountability Office (GAO), while Medicare provides coverage for about 64 million older Americans and those with certain disabilities.

The California-based Center for Connected Health Policy (CCHP) developed a list of areas where telehealth is practiced.

Synchronous Video Conferencing. Live conversations between clinicians and patients using various audio/visual communications technology. As for types of visits, they include everything from going over routine lab results to a mental health counseling session.

Store-and-Forward. Asynchronous communication such as transmitting recorded health history to a practitioner, often a specialist, who uses the information to evaluate a patient’s condition.

Remote Patient Monitoring (RPM). This involves wearable, connected medical devices that collect health data from a patient in one location (typically their home) for transmission to a provider in a different location.

Mobile Health. This refers to any healthcare-related communication using cell phones, tablets and PDAs. The type of communication can range from one-on-one conversations between a patient and a clinician to text messages to large groups from health educators promoting healthy behaviors or alerts about disease outbreaks.

Health Equity Issues With Telemedicine

Given the wide range of services provided and the popularity with patients, digital care services represent the future of healthcare for many people. However, achieving true health equity will require changes to the current approach, both in healthcare and technology.

Extending Telehealth Availability

Expanding Medicaid and Medicare coverage to include telehealth services during the pandemic is not permanent. Before that change, no Medicare patients had telehealth covered. Medicaid only paid for digital health services under a limited number of specific examples, such as when a patient’s location limited their access to in-patient care.

The GAO found that the use of telehealth services by Medicaid patients increased 15 times during the pandemic, while the use of telehealth by Medicare patients increased 10 times between 2020 and 2021.

The U.S. House of Representatives passed the Advancing Telehealth Beyond COVID-19 Act in 2022. The act, which extends Medicare coverage of telehealth through at least 2024, is currently in a Senate committee for consideration. The act, introduced by Wyoming Rep. Liz Cheney, allows:

  • Patients to continue receiving telehealth services at any site, regardless of type or location
  • Occupational therapists, physical therapists, speech-language pathologists and audiologists to continue providing telehealth services
  • Health centers and rural health clinics to continue to serve as a “distant site,” the location of the health care practitioner who provides telehealth services
  • Hospice physicians and nurse practitioners to continue completing certain requirements relating to patient recertifications via telehealth

Address Access to Telemedicine

Even if Congress continues to act, achieving health equity will require addressing the existing technology barriers for patients and providers.

In its report on telemedicine, the GAO noted that previous research has shown that “millions of Americans still lack access to high-speed internet.” The GAO suggests that certain healthcare providers, especially small medical practices, may lack the technological tools to facilitate a confidential and secure video consultation. Additionally, patients may not be fully informed about the potential privacy and security risks related to telehealth technology.

The U.S. Congress has invested billions in broadband expansion across the country. However, those living in rural areas, as well as low-income people in both rural and urban areas, are less likely to have reliable access to the internet or own a smartphone, tablet or laptop computer.

Kaiser Permanente suggests a three-pronged approach by federal and state lawmakers in addition to making Medicare and Medicaid coverage of telehealth services permanent.

  • Continue to establish high-quality standards for healthcare providers to govern telehealth (such as ensuring they have secure electronic records systems)
  • Expand investment into providing reliable broadband services to low-income and rural areas
  • Support efforts to train both healthcare practitioners and patients on the proper use of digital health services technology