Jun 21 2021
Patient-Centered Care

#ATA2021: Telehealth Can Improve Access to Care in Rural and Urban Communities

People in rural and urban areas face unique barriers to healthcare access. Virtual care can bridge the gap for many, but programs should be designed with equity in mind.

Telehealth plays an important role in expanding healthcare access. However, providers must overcome additional challenges to reach remote and marginalized communities. Both rural and urban populations have their own unique barriers to care, which can include distance, limited broadband access, distrust and more.

During two panel discussions held during the American Telemedicine Association’s 2021 virtual conference, healthcare professionals discussed access disparities and how virtual care can bridge the digital divide.

Telehealth Expands Access to Care in Rural Areas

West Virginia University Health System has established six telemedicine hubs throughout West Virginia to accommodate people in rural communities. Shannon McAllister, assistant vice president of population health and telemedicine for the hospital system, said the goal is to provide shorter travel times for patients to connect with specialists.

A patient can travel to a strategically located telemedicine hub, rather than having to travel to the academic medical center in Morgantown, W.Va., where many of the providers are located. The hubs also reduce costs for patients. Advanced practice providers, or APPs, facilitate the virtual visits with specialists located at one of WVU’s hospitals.

MORE FROM ATA2021: How remote patient monitoring can provide insightful patient care.

“It’s offered both patient and provider satisfaction, and it allows the providers to work at the top of their license without having to travel. The APP tees up the visit and presents cases to them,” said McAllister. “Providers can see patients from all over the state in a single day without causing wait times for any location. This has increased access to care and reduced costs because physicians are more efficient with their time.”

Patients who don’t have access to technology or need help using telehealth technology can also use the telemedicine hub. In addition to increased access, McAllister said the program has increased overall patient compliance with care plans.

“If you reduce barriers, it’s easier for them to participate in care as recommended by the care provider,” she said.

McAllister emphasized the importance of listening to patients and understanding their barriers to care when formulating a telehealth plan. To gain provider buy-in, she said, the first step is to simplify the workflow and build as much of the program as possible within the electronic medical record process. To make adoption easier for providers, WVU Medicine created short videos and tip sheets to communicate key points and documentation requirements.

“By making care more efficient and accessible, you can engage more patients, creating a healthier community,” said McAllister.

ATA rural healthcare session

ATA2021 panelists discuss how telehealth expands access to care in rural areas.

Traci Thibodeaux, CEO of Beauregard Health System, said the 49-bed acute care hospital in DeRidder, La., has had difficulty recruiting specialists.

“The quickest approach was to deploy a telemedicine strategy since we had access to specialist providers in tertiary centers,” said Thibodeaux.

In some cases, a physician visits Beauregard Health System two days a week and then supports the hospital via a telehealth platform at other times, which Thibodeaux said has added value to the community.

The staff’s concerns prior to launching the telehealth program were reimbursement challenges due to patient experience and the Centers for Medicare & Medicaid Services’ originating site rule.

“We knew the nursing staff would be an integral part of this process,” said Thibodeaux. “We wanted to provide a reliable experience, with telehealth being a predictable tool in our arsenal.”

She explained that the implementation of telehealth had wonderful, unintended consequences as well. Fewer patients were transferred to tertiary centers because some specialist care could be provided via telehealth. This meant patients could remain in a familiar environment and family members would have fewer logistical concerns. Telehealth helped the hospital provide consistent consultations, which propagated trust in the community. Additionally, Thibodeaux said, the nurses credited telemedicine with making them better nurses because of the education gained from assisting specialists.

“It’s important in rural communities to keep care local when it’s appropriate and safe to do so. It’s important to recovery, family and other support systems, and for the primary care physician,” she said.

Thibodeaux recommended a collaborative approach to implementing telehealth services. She said it’s essential to involve bedside nurses and the local medical staff to figure out which specialists are needed and how the program should be framed.

Broadband access can be a challenge for people in rural and urban areas. Thibodeaux pointed out that bringing affordable fiber-optic internet to rural communities is vital. A loosening of telehealth regulations would also help expand care access.

McAllister added that the uncertainty surrounding which telehealth services will still be reimbursed after the public health emergency ends has made expanding telehealth services difficult for WVU.

Community Resources Key to Reaching More People in Urban Areas 

Many of those lacking access to care in urban areas are people of color and low-income patients. Gary Butts, chief diversity and inclusion officer and executive vice president for diversity, equity and inclusion at Mount Sinai Health System in New York, said access disparities became more apparent early in the pandemic.

“We were concerned that telehealth would become more available to people who could easily access it, and that’s what happened,” said Butts. “Telemedicine will be an important component of healthcare delivery. Some gaps may have widened, especially for people without broadband, but the good news is we’re positioning ourselves to address those issues. However, it’s a reminder of what’s been broken for decades in access to services for people of color.”

Krisda Chaiyachati, medical director of Penn Medicine OnDemand Virtual Care, said transportation can be a major barrier to care in urban areas. While a hospital may be nearby, it’s not always easy for someone who is sick or who lacks transportation to get there. The cost of traveling and parking can also be a barrier. In addition, an in-person visit can be a burden to people who are unable to take time off from work.

“We had the highest show rate when using a hybrid approach with both telehealth and in-person services,” said Chaiyachati. “A small amount of digital access shifted people’s access to care.”

ATA urban healthcare session

During an ATA2021 session titled "Overcoming Healthcare’s Challenges in Urban Areas," panelists discuss barriers to care for marginalized communities in urban areas.

He explained that doubling down on telehealth services could create a dramatic improvement in care access. However, other barriers still exist for many low-income patients.

“Upload and download speeds get spottier in low-income areas. Maps of broadband speed only show what the speed could be, not whether people can afford a modem or a faster plan,” he said. “We have to broaden what digital access means to enable virtual care.”

Audio-only telehealth encounters could fill in the gaps for some patients, Chaiyachati said. While some clinical conditions would benefit from a video call, others could be handled using a less technology.

Eddie González-Novoa, dean of multi-hyphenates at Liberation Health Strategies, said that in addition to a digital divide, there is a divide of trust, which telemedicine can help bridge.

He pointed out that marginalized communities have faced epidemics in the past, and that some health models may not work if they don’t take lived experience into consideration.

“Communities have been in crisis before and have a history of innovating. We need to tap into the resources and innovations within communities,” he said.

Adimika Arthur, executive director at HealthTech 4 Medicaid, said reimbursement, licensure, parity, geography and community infrastructure remain barriers to care for many in urban areas. She pointed out that some public housing lacks access to broadband.

MORE FROM ATA2021: Dr. Joseph Kvedar explains what’s next for telehealth.

“We have an incredible opportunity to use telehealth as a tool and vehicle, but we need to think about structural, institutional and societal racism and how that plays into the care of who we serve,” she said. “It’s important to recognize the wisdom of a community. People have been running businesses in communities for, sometimes, a hundred years, and those shadow infrastructures exist.”

Chaiyachati explained that community members need to be part of the decision process when implementing telehealth services. They can be digital health navigators to help build trust within a community. It’s important to start by asking who is underserved, he said, in order to find ways to reach them.

Keep this page bookmarked for articles from the event, which runs through June 29. Follow us on Twitter @HealthTechMag as well as the official organization account, @AmericanTelemed, and join the conversation using the hashtags #ATA2021 and #GoTelehealth.

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