Opinion: As Telehealth Expands, We Must Include Diverse Communities

Online Consultation with their Doctor
Photo by Geber86/iStock.

Telehealth has proliferated as a result of COVID-19. Data from the federal Centers for Medicare and Medicaid show the number of telehealth visits nationwide in the early weeks of the pandemic skyrocketed to 1.7 million from just 13,000 the week before. This increase occurred in California as well.

The rise in telehealth has tremendous potential to improve the health of those who have historically lacked access to medical care. Low-income people and those living in rural or medically underserved areas can use telehealth to more easily connect to specialists and manage chronic conditions from home. Virtual visits, which have been shown as comparable to in-person visits for certain services, can ease patient burden in terms of transportation costs or lost wages due to time away from work.

But this rapid deployment of technology has not fully accounted for the needs of Black and indigenous Californians, or other people of color, including those with limited English proficiency or disabilities. A recent evaluation at UCSF medical center and Zuckerberg San Francisco General Hospital for example, found that while video and telephone visits increased during a two-week period during COVID-19, compared to the same timeframe before the pandemic, the proportion of visits by people at risk for limited digital literacy decreased significantly. This group includes seniors, patients who don’t speak English and those with Medicare or Medicaid.

Since before COVID-19, we’ve known that structural racism in health care creates and perpetuates deep inequities that manifest in higher rates of uninsurance, lack of access to health providers, negative experiences in health care and poorer health outcomes. Moreover, people of color are underrepresented in health professions, resulting in frequent cultural and linguistic incongruence between consumers and providers.

So how can we ensure that the rapid adoption of telehealth adequately addresses these deeply entrenched racial inequities without leaving our communities behind?

The California Pan-Ethnic Health Network (CPEHN) fielded an online consumer experience survey in English, Spanish, Chinese and Korean to try to understand the experiences people of color and those with limited English proficiency have when accessing telehealth.

Survey respondents overwhelmingly reported satisfaction with telehealth. Nearly 90 percent of Black respondents, for example, reported satisfaction with their telehealth visit overall and equal or greater satisfaction with telehealth than with in-person medical care. These findings were corroborated by a recent California Health Care Foundation survey of low-income consumers which found similarly high patient satisfaction rates.

While this data points to the promise of telehealth, our survey found  there are also significant challenges to overcome in order to ensure that any longer-term shift to telehealth lessens disparate access and improves health equity. These include:

  • Technology Education: We must equip consumers, especially those less adept at using technology, such as seniors, with the education, preparation and assistance to ensure they can comfortably use telehealth. Forty percent of consumers surveyed reported they did not receive any instruction from their provider on how to prepare for or access their telehealth appointment.
  • Access to Technology: Future policymaking must view access to technology, including broadband and phone minutes, as a health equity issue. People with low incomes, those living in rural areas, and Black and Latino households are more likely to lack a broadband subscription. In our survey, 62 percent of Latinx respondents reported they do not have a strong enough internet connection to access telehealth.
  • Telehealth Parity: Expansion plans for telehealth must consider coverage, payment and the adoption of virtual care teams. Health insurers should be required to provide coverage for telehealth visits in parity with in-person visits, and provide adequate coverage for equipment such as smart tablets, blood pressure cuffs and scales to monitor health conditions remotely.

Telehealth provides more opportunities for patients to access care at a time and place that is convenient to them, potentially eliminating some barriers like transportation, time away from work and child care. Patients could also have access to broader and more culturally aware providers. A Korean-speaking patient in Sacramento could have a virtual visit with a Korean-speaking provider in Los Angeles, for example.

Telehealth adoption holds great potential for health equity — but it must be designed with diverse communities in mind.

Kiran Savage-Sangwan is the executive director of the California Pan Ethnic Health Network, a statewide health advocacy organization focused on addressing racial and ethnic health disparities.

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