Telehealth used less in disadvantaged areas, Health Affairs study finds
A Health Affairs study found that telemedicine use during the COVID-19 pandemic was lower in communities with higher rates of poverty – suggesting that the industry must address the digital divide in order to ensure widespread access to virtual care.
The study, which was conducted by researchers from Harvard and the RAND Corporation, examined the variation in total outpatient visits and telemedicine use among 16.7 million commercially insured and Medicare Advantage enrollees from January through June 2020.
"Although the increase in telemedicine use during the pandemic is widely recognized, it is unclear how the use of telemedicine and in-person care has varied across patient demographics, clinical specialties, and medical conditions," wrote the research team.
During the COVID-19 period of the study, researchers found that 30.1% of total visits were provided via telemedicine – with a whopping twenty-three-fold increase in weekly number of telemedicine visits, compared to the pre-COVID-19 period.
Still, overall visit volume decreased by 35%, raising concerns about the impact of deferred care in the future.
WHY IT MATTERS
Telehealth has been hailed as a panacea for unequal access to care, but the data has repeatedly suggested otherwise.
Researchers found that the percentage of total visits provided via telemedicine was smallest among those older than 65. Rural counties also saw lower percentages of telemedicine use when compared to urban counties.
When it comes to clinical specialties, the study found that before March 17, 2020, fewer than 2% of clinicians in each specialty delivered any outpatient care via telemedicine, with the exception of mental health clinicians.
During the COVID-19 period, psychiatrists, gastroenterologists, endocrinologists and social workers provided more than half of their visits virtually, with psychologists and neurologists not far behind.
By contrast, specialties such as ophthalmology lost most of their clinical volume early in the pandemic.
"Although there was variability in the magnitude of changes across different patient populations and clinical disciplines, every segment of the health care system experienced a drop in the overall volume of care, including important common chronic conditions such as diabetes and hypertension," wrote the researchers.
Researchers also noted lower telemedicine use in high-poverty areas, while also flagging that the study population disproportionately included employed adults and their family members with commercial insurance. In a separate Health Affairs blog, health policy experts noted that Medicaid users have had "less consistent" access to telemedicine.
THE LARGER TREND
As questions linger about the future of telehealth amid a continuing pandemic, researchers and advocates are examining which people have benefited from expanded access – and who has been left behind.
A wide-ranging study published in December found that older people, women, Black and Latinx individuals and patients with lower household incomes were less likely to use video for telemedicine care, and that older patients, Asian people and non-English-speaking people had lower rates of completed telehealth visits.
"We must be intentional with implementation to ensure that all patients are equipped to effectively participate in telemedicine care," wrote the researchers in that study.
ON THE RECORD
"Our analyses, replicated at the health system level, could inform policy to make up for months of deferred care," said Health Affairs researchers.
"Health systems could allocate resources to patient outreach efforts such as telephone calls or reminder messages, prioritizing patients whose conditions saw the largest drop in visit volume. Furthermore, additional clinical capacity could be allocated to specialties with the largest backlogs of deferred care," they wrote.
"Finally, health systems could prioritize chronic illness populations, who were more likely to have deferred care, for targeted population management."
Focus on Health Equity
This month we will be reporting on the challenges, opportunities and success stories as work continues to build a healthcare system that works for everyone.