Audio-Only Telehealth Used More Than Video Visits in Safety Net Clinics

New research published in the Journal of the American Medical Association revealed that audio-only telehealth continues to be used at higher rates than video visits in safety net clinics in California, but further investigations into care quality and health equity are needed.

In the early stages of the COVID-19 pandemic, both audio-only and video-based telehealth were highly used, largely due to restrictions on in-person care along with increased reimbursement from payers. Despite this increase in use, questions surrounding the efficacy of audio-only telehealth in safety net settings arose, mainly related to its ability to treat low-income patients.

To gather further insight into this, RAND Corp. researchers gathered information regarding how telehealth evolved between February 2019 and August 2022 at safety net clinics. They examined data from 30 multisite federally qualified health centers (FQHCs) in California, which included information about billable in-person and telehealth visits. In total, these FQHCs care for 1.3 million lower-income people, many of whom reside in rural areas.

From an analysis of this information, researchers found that between February 2020 and August 2022, primary care visits increased by 8.5 percent, while behavioral visits increased by 23 percent across the FQHCs. They also noted that the use of audio-only telehealth for primary care was at its highest in April 2020, while its usage for behavioral health peaked in March 2021.

In April 2020, the share of in-person visits for primary care was 30 percent, increasing to 71 percent in August 2022. Meanwhile, audio-only telehealth dropped from 67 percent to 21 percent, and video visits rose from 4 percent to 7 percent for primary care.

Similarly, in-person visits for behavioral health rose between April 2020 and August 2022, from 20 percent to 37 percent. But, like primary care again, audio-only telehealth for behavioral healthcare dropped during this time, and video visits increased. Specifically, audio-only service use declined from 74 percent to 39 percent, and video visits rose from 8 percent to 23 percent.

Although the use of audio-only telehealth for both primary care and behavioral dropped between 2020 and 2022, researchers noted that its continued usage is likely due to clinics not having access to the technology needed for video-based telehealth.

They also noted that the Medicaid Program of California (Medi-Cal) provided permanent payment parity for this type of telehealth, indicating that there are no financial incentives associated with eliminating audio-only telehealth.

Although audio-only telehealth remains in use, researchers noted that studies surrounding its efficacy are needed.

“It appears likely that audio only visits in these settings will remain widespread in coming years,” Lori Uscher-Pines, lead author of the study and a senior policy researcher at nonprofit research organization RAND, in a press release. “More research is needed on the effectiveness of audio-only visits to inform their use in safety net settings.”

Previous studies have indicated that audio-only telehealth can effectively be used to treat vulnerable populations.

For example, a study from August 2022 described that audio-only telehealth provided benefits that were comparable to video-based telehealth when treating underserved patients.

Researchers reached this conclusion after conducting a clinical trial involving patients participating in a clinic visit via phone or video-based telehealth. While considering various factors such as sex, race, and employment, researchers used satisfaction rate as the main unit of measurement.

Following a review of the data, they found that although there was a slight difference in satisfaction levels between the two modalities, satisfaction rates did not exceed the margin needed to establish inferiority.