COVID-19 has exposed as well as exacerbated health disparities in the United States. Communities of color are contracting and dying from COVID-19 at higher rates as they endure underlying conditions stemming from intergenerational trauma, work in high-risk jobs that are deemed essential, and have less access to health care. Simultaneously, the pandemic has shown that telehealth can be used as a tool to deliver critical health care when patients are not able to receive services in person. Could the promise of telehealth also help underserved and heavily impacted populations during COVID and beyond?
Telehealth – Fulfilling the Promise for Underserved Communities
Even before the public health emergency, evidence showed that telehealth can improve access to care. It can save money and time for those who do not have access to transportation or a trusted provider, have caretaking duties, cannot take too much time off work, or simply would rather receive services from their own home. Moreover, many patients may simply not feel comfortable in a health care setting and would rather get care on their own terms. That can ring true for populations who have long been discriminated against in health care systems, like communities of color.
Acceptance and satisfaction with telehealth, primarily among communities of color, is rising. In a survey conducted by AARP in the spring of 2020 among adults ages 18-65, a vast majority of respondents expressed an interest in the concept of telehealth; in fact, Black and Latinx individuals expressed more interest than their white counterparts in using telehealth for providing care to a loved one and for routine doctor visits. Similarly, a recently-published UCLA report described how telehealth interventions like mobile behavioral health treatments and remote blood pressure measurements have proven successful among the Latinx community.
A Few Words of Caution
Telehealth is not the only solution to improve access to health care, but should be considered as part of a long-term, sustained strategy to address problems regarding access and convenience. While telehealth can be a complementary way to access services, it should not fully replace in person care as patients should reserve the right to receive the services that are best for them.
In addition, telehealth services should be subject to federal and state privacy and confidentiality laws (although it has made sense to temporarily waive some of the penalties for HIPAA requirements during the public health emergency). Similarly, measures to protect against fraud should be the norm. Just as fraud occurs in other health services, it can also occur via telehealth.
Recommendations for Equitable Access to Telehealth
All populations should have the resources and support to have the highest quality of care available through a telehealth interaction. For the telehealth promise to become a reality, broadband (high speed internet) must be available and affordable to every individual. Low-income households, rural areas, as well as Black and Latinx populations disproportionately lack access to broadband that enables telehealth utilization. We must bridge the digital divide if telehealth is to be fully adopted by those who need it.
Additionally, Medicaid enrollees and low-income populations should have access to devices that enable a telehealth interaction. Even some individuals with access to computers do not know how to use them properly; particularly those who are older, less educated, Black or Latinx. Digital literacy is critical as well – for providers, their staff, and patients. Conducting extensive public outreach—including trainings and awareness campaigns among providers, their support staff, and communities—is critical. Access to language interpreters during telehealth services should also be available.
The pandemic offers us an opportunity to study the outcomes of those who are and should be benefiting from telehealth. Federal and state governments as well as researchers should analyze the health outcomes among low-income patients. Policymakers should fund research on telehealth best practices for patient safety and effectiveness.
Conclusion
The COVID-19 public health emergency has demonstrated that telehealth is here to stay and that it could be especially helpful for those who have limited access to care. At the same time, those who need telehealth the most are the ones who have the least access to it. As such, governments should invest in creating the infrastructure—connectivity, equipment, and education—to make the telehealth promise a reality.
