The global pandemic has catalyzed the already rapid growth of telehealth. Even with many states loosening COVID-19 regulations and moving towards different phases of reopening, it is clear that telehealth is an innovation that is here to stay, long after a vaccine for the virus is developed.
Startups like SonderMind, Hims & Hers, and Heal are raising hundreds of millions of dollars to bring medical care directly to patients and it will be important to consider the equity implications as these telemedicine companies grow, and what companies and elected officials can do to ensure that vulnerable populations are not left behind.
In our own work, Cerrell has seen how critical it is to put patients first when developing public policy. Here’s how we would think about ensuring equity in the growing telehealth space.
Replacing In-Person Care?
Telehealth will never totally replace in-person care, but its rise opens up a range of possibilities to make patient care more accessible. Congress allocated $200 million for telehealth in the CARES Act in response to the COVID-19 pandemic, putting considerable weight behind the growing sector.
Telehealth has the opportunity to transform medical care and make meeting with providers easier for those with mobility issues, rare chronic conditions, mental health concerns or located in remote areas or in a place with limited providers. It removes some of the barriers to care like transportation, and allows for appointments at times that are more convenient for those working multiple jobs or who cannot easily take time off.
It is cheaper to provide telehealth than in-person care and can direct patients away from unnecessary emergency room visits, making telehealth an efficient and effective way to deliver care for patients across the country.
However, it is not without its challenges.
In our work with LISC and the Los Angeles Regional COVID Fund, we’ve learned how important intentional communication is with vulnerable populations during this crisis and the different channels and methods needed to reach them.
Research shows that these digital barriers are found more frequently in rural populations, older adults, minority populations, and those with low socioeconomic status and limited English language skills. For example, among American seniors who are most likely to need chronic disease management, only a little over half own a smartphone or have internet access at home. (Nouri, et al)
Cerrell partners with community organizations that are deeply involved with these communities in our work with PhRMA and know the value that telehealth could bring to these patients. The digital barriers pose a huge problem for healthcare providers and startups who need to engage with these populations. This digital divide also excludes those patients who could benefit from telehealth the most. By connecting with existing community partners, telehealth organizations can develop relations that bring their services directly to the communities that need them most.
The digital divide is not just lack of access to technology, it is also a lack of education. Companies need to be intentional when creating their user experience, so that patients don’t have to jump through hoops or follow multiple steps to register or create a profile.
Addressing equity in telehealth means creating products and experiences that are simple, and easy to use, with clear instructions in a wide variety of languages. Cerrell does the same work when creating public education campaigns that need to be accessible to multiple constituencies. It has been shown that the need to create a patient portal before accessing care can make a patient overwhelmed and quit the process of accessing care. (Nouri, et al) It’s vital that accessing care be simple and without complication, especially for vulnerable patients.
It is up to companies and elected officials to work together to mitigate these challenges to ensure that no patient is left behind as virtual care becomes more mainstream. While there are also privacy and other regulatory issues that will need to be dealt with, there are some actions that companies can take now to push for wider access to telehealth.
There needs to be a concerted effort to connect patients with free or subsidized internet access to overcome the technology barrier for vulnerable patients. The digital divide for seniors and rural residents is real – and there are real solutions.
Advocate for internet to be considered a public utility. Push for video-enabled devices to be in every household. Schools across the country are making this happen for students during the COVID-19 crisis, and could be a great model for healthcare companies. (Velasquez, Mehrotra) Companies should partner with those in communities who are already working on this issue of digital literacy and access, to most effectively get devices and internet access into the homes of those patients that need it most.
Working with programs like Medicaid, there can be a huge expansion of telehealth offerings, making reimbursement easier for providers, and ensure vulnerable patients, like those on Medicaid, are not left out.
Ultimately, telehealth can be a gamechanger for equity in healthcare by making care more easily accessible. If companies and government work together to push for greater and cheaper broadband internet access and digital literacy, advocate for regulations that make telehealth easier to implement, and connect with patient advocates to best understand how to create user experiences that work for underserved communities and vulnerable patients, telehealth will revolutionize the way we receive and request healthcare.
Cerrell has worked with technology companies, the life science industry, hospitals, and healthcare non-profits in California for over 50 years. If you’re a telehealth company that is looking to engage with local, state and federally elected leaders, push for public policy solutions, or work with communities to expand your social impact work, we are here to help.
Mason, A. (2020, September 9). What Will It Take to Achieve True Equity in Telehealth? [Editorial]. HealthTech. Retrieved from https://healthtechmagazine.net/article/2020/09/what-will-it-take-achieve-true-equity-telehealth
Nouri, S, Khoong, E, Lyles, C, & Karliner, L. (2020). Addressing Equity in Telemedicine for Chronic Disease Management During the Covid-19 Pandemic. NEJM Catalyst | Innovations in Care Delivery. DOI:10.1056/CAT.20.0123
Shachar C., Engel J., Elwyn G. Implications for Telehealth in a Postpandemic Future: Regulatory and Privacy Issues. JAMA. 2020;323(23):2375–2376. doi:10.1001/jama.2020.7943
Velasquez, D., & Mehrotra, A. (2020, May 8). Ensuring the Growth of Telehealth During COVID-19 Does Not Exacerbate Disparities in Care Health Affairs. Retrieved from https://www.healthaffairs.org/do/10.1377/hblog20200505.591306/full/