Telehealth Now: Opportunities for Equity and Challenges

December 13th, 2021 | Viewpoint

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Before the pandemic, telehealth was full of far-off potential. It would one day be able to improve access, especially for harder-to-reach patients, alleviate scheduling pressures, and reduce disparities. But that potential was largely untapped.

There were funding and reimbursement challenges. Technology challenges. And an undercurrent of resistance to the unknown. Telehealth programs that did exist were based primarily within the clinic’s four walls and were used narrowly, such as for consultations with distant specialists. 

Before March 2020, advancing telehealth was a component of JSI’s Health Information and Technology, Evaluation, and Quality (HITEQ) Center, funded by the Health Resources Services Administration. The HITEQ Center, led by Jillian Maccini for the past 2 years, supports health centers’ technology needs. Prior to 2020, about 43% of health centers offered some telehealth, but that accounted for less than 1% of health center visits. When it became imperative to keep people home as much as possible to reduce the spread of COVID-19, telehealth moved from potential to essential.

All of a sudden, we had infinitely more flexibility,” says Maccini. “So many more things are possible.”

Many obstacles were eliminated. Some cross-state licensure requirements were suspended. Funding was made available through federal, state, and private insurance programs. This required coordination from multiple agencies such as the Centers for Medicaid and Medicare Services, which determines reimbursement; the Office of Civil Rights, which oversees HIPAA compliance; and the Drug Enforcement Administration. 

It was a steep but quick learning curve to implement concepts that had been discussed and researched over the years. Health care centers shift from traditional practices and developed new protocols and procedures. 

In many ways, the foray into broadly delivered telehealth exceeded expectations. It became easier to schedule routine appointments, and for patients to keep them. Care was extended to people who wouldn’t or couldn’t come into a clinic. 

When people come to an office for a health appointment, providers rely on what they choose to reveal about their lives and what is happening at home. But when the appointment is virtual, providers can glimpse it themselves. They can see if patients are caring for young children or elderly parents, if the home is furnished, or even if there is a home at all. 

Health care providers who had been concerned about the diminished physical contact with patients found ways to connect over the screen. They appreciated the ability to see another side of patients.

“When you see a patient in the office, they’re in your realm. When you see a patient at home, you have a better sense of what life is like,” notes Maccini. “It’s this whole-person experience. You don’t have control over the patient, but there are some upsides to that. You are meeting people where they are.”

But some of the things that had held back enthusiasm for telehealth prior to the pandemic emerged as real challenges. 

Some people don’t have access to technology or they have limited WIFI. Some struggle to navigate online programs and telehealth tools. And it’s required a major shift in procedures. At a clinic, a patient may be seen by one provider and then brought down the hall to see a specialist. These handoffs are harder to navigate virtually.

As the pandemic comes under control and health centers have reopened, the approach to telehealth is evolving, Maccini says. Some previous concerns and obstacles have re-emerged. For example, during the pandemic, service models shifted to accommodate virtual visits. But now there are questions about how they will fit within a system that is designed around in-person care. There will also be funding questions as payers decide if and how they will continue to cover telehealth. Additionally, ongoing tech hurdles exclude some patients. But now we know that telehealth can reduce disparities and improve the delivery of health care.

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