The COVID-19 pandemic precipitated widespread implementation of telehealth throughout the United States. Almost overnight, payment challenges limiting telehealth implementation were removed and patients were able to see their doctors virtually. Unfortunately, there was much more attention to the volume of telehealth use than to when, why and how telehealth is most helpful to the people receiving care.
Few clinicians were trained on how to deliver effective care through telehealth, i.e., how to successfully use virtual platforms to reinforce patient-provider relationships, deliver accurate diagnoses, provide appropriate treatment, and create better outcomes for patients. These questions are particularly acute for Federally Qualified Health Centers (FQHCs), which serve a predominately low-income, underinsured, and vulnerable patient base with high rates of chronic disease.
St. David’s Foundation supported a research project by the Value Institute for Health and Care at the University of Texas to learn about the telehealth-related needs of underserved populations and how telehealth can be used to improve the health outcomes of individuals and families.
This white paper summarizes findings from the literature on telehealth use in FQHCs and in other underserved populations. It also includes perspectives from employees at two Central Texas FQHCs, Community Health Centers of South Central Texas, (CHCSCT) and Lone Star Circle of Care (LSCC), on the potential of telehealth to improve health outcomes and increase health equity across the health care system.
Telehealth has expanded access for many patients by making it easier, less time-intensive, and more comfortable for them to receive health care. The biggest opportunities for improvement in health outcomes, and thus value creation, with telehealth seem to be in the areas of chronic disease management, particularly if paired with remote monitoring, and mental health care. However, disparities in internet access, smartphone ownership, and language interpretation services present major challenges to ensuring that telehealth services contribute to reducing health inequities.
The Power of Relationships
Telehealth needs to support relationships. One study focused on health equity found that continuing to offer in-person visits alongside telehealth services was key to building and maintaining trust with patients. The leaders we interviewed at CHCSCT and LSCC echoed this idea, explaining that they never closed their clinics to in-person visits during the pandemic and believed this was an important signal to patients that they could continue to count on the FQHCs.
Barriers to Telehealth Access and Care
The American Medical Association’s 2021 survey of physicians found that lack of insurance coverage and either low or no payer reimbursement were the most commonly identified barriers to implementing and continuing telehealth services. From respondents’ perspectives, the top three barriers facing their patients were technology, digital literacy, and broadband internet access.
Telehealth Can Bridge Gaps in Care and Support Health Equity
While lack of cellular or internet access blocks the opportunity for some patients, for those who can connect, telehealth may enable care that “fits” a person’s cultural and language preferences when deployed with that goal in mind. For example, participants with depression mentioned using telehealth to receive care from a therapist in a different country so they could talk to someone in their native language.