Aug 07 2020

Why Providers Should Address Disparities in Telehealth Access

Delivering virtual care to everyone requires adaptation, training and deep insights into issues that can hinder a connection.

Healthcare organizations nationwide have quickly launched or scaled up telehealth programs to ensure patients can safely receive necessary care while limiting their exposure to COVID-19.

But many providers also face the challenge of ensuring that the platforms are accessible to all patients — including traditionally underserved populations that may lack devices and bandwidth.

Boston Medical Center, the largest safety net hospital in New England, focused on phone visits when it began offering virtual care in mid-March. Within 48 hours, the hospital was handling 1,500 phone visits a day, Dr. Rebecca Mishuris, BMC’s associate chief medical information officer, tells HealthTech. This is compared with about 3,000 in-person ambulatory care visits per day.

Patient access to technology is obviously concerning to us,” Mishuris says. “We know almost all of our patients have phones, but many don’t have smartphones or a computer or internet connectivity — or if they do, they’re on a limited data plan.”

Now, when patients call in as a first touchpoint in their search for care, BMC staff members try to find out if individuals have the necessary hardware and bandwidth to support virtual visits and home-based healthcare.

BMC leadership describes this divide as the “21st-century social determinant of health,” Mishuris notes.

“A lot of healthcare is digital, whether it’s access to a portal or a phone app for tracking weight or blood sugar,” she says. “If our patients don’t have access to it, we’re leaving them behind.”

Deliver Virtual Care Through Community Sites for Greater Access

Intermountain Healthcare, Utah’s largest health system, has a robust telehealth program anchored by a virtual hospital. As virtual-visit growth skyrocketed — from 80 visits per month in February to 60,000 visits per week in April — the system saw a need to make sure its rural patients were not left behind.

“There are many different barriers that come into play for giving people in rural areas the same level of healthcare, whether it’s geography, economy, education or health literacy,” says Dr. Kerry Palakanis, executive director of Intermountain Connect Care, the organization’s telehealth platform.

The health system’s teleoncology program, for example, enables residents of rural parts of Utah (as well as Idaho and Montana) to receive chemotherapy and consult with oncologists via community hospitals.

Patients avoid hours-long commutes to Salt Lake City over and through the mountains — which could exacerbate nausea after chemo — and save time and money. It may also help patients avoid missing extra time from their jobs.

“It’s not a different way to provide care, it’s a different way to access care,” says Palakanis, who has spent the bulk of her 35-year career working in underserved rural and frontier areas. “Most people in rural areas will give up and wouldn’t go for treatment if the teleoncology didn’t exist. A small drop of an impact has a huge ripple effect.”

READ MORE: Learn how Intermountain and other organizations met the vast need for virtual care.

Make Primary Care a Core Component of Telehealth

Simply implementing virtual-visit technology to deliver high-quality care isn’t enough to serve vulnerable populations, Palakanis and other healthcare leaders know

Clinical workflows, staffing, training, infrastructure and payment models all need to be adjusted.

To address these needs, researchers from the University of California, Los Angeles have released a series of reports that address the needs of underserved populations in California that provide several policy recommendations.

In the Golden State alone, 7 million people live in an area with a shortage of healthcare providers; the state also has a shortage of 54,000 Latino physicians, says Dr. David Hayes-Bautista, a professor of medicine and director of the Center for the Study of Latino Health and Culture at the David Geffen School of Medicine at UCLA.

“Telehealth is a new way of doing things. It could provide access in areas where there are shortages, which is true in many Latino areas,” Hayes-Bautista says. “We can get the physician eye out into underserved areas” that physicians and brick-and-mortar hospitals have passed by.

The UCLA Health policy recommendations for increasing access to care using telehealth include increased investment in medical interpreters, expanded reimbursement, expanded access to broadband internet and — perhaps most important — an emphasis on primary care.

“Before we talk about helping someone when they have something new, we need to keep primary care going,” Hayes-Bautista says. “Unless patients have a good relationship with a provider, we’ll never know what’s happening to them.”

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