Telehealth Boosts Access to Care in MA, But Health Equity Gaps Remain

A recent report, funded by the Massachusetts Association of Health Plans, describes how telehealth has proven to be widely beneficial for state residents and provides recommendations to optimize virtual care delivery within the Commonwealth.

The report was compiled by researchers from the Department of Population Medicine at the Harvard Pilgrim Health Care Institute and the Massachusetts Health Quality Partners.

As restrictions to in-person care proliferated due to the COVID-19 pandemic, many patients and providers turned to telehealth. Researchers found that as this adoption took place in the Commonwealth, there were many apparent healthcare disparities resulting from the digital divide.

The digital divide refers to the inability to access virtual healthcare due to technology-related barriers, most of which relate to digital literacy, financial stability, and internet access.

To gain further insight into the effect of telehealth use on patient care, researchers conducted a mixed-methods research study that included a quantitative distributed analysis of healthcare claims with qualitative stakeholder interviews. The study involved an analysis of enrollment and claims data of over 1.8 million patients, along with qualitative data from more than 35 hours of interviews.

Researchers measured use by analyzing monthly enrollment and outpatient and telehealth visits for a 36-month period between January 2019 and December 2021. They found that as telehealth use increased amid the COVID-19 pandemic, there were variations when comparing geographical location, age, insurance, visit type, and socioeconomic background. For instance, seniors, children, residents with low digital access, and rural and low socioeconomic status communities were least likely to use telehealth services.

Based on the data and the information gleaned from interviews, researchers shared insights related to access and utilization, visit experience, and visit quality.

Barriers to telehealth access and utilization included the lack of a usual source of primary care, lack of internet connectivity and devices along with the lack of understanding of how to use technology, researchers noted. 

With regard to patient experience, researchers found that convenience was a primary driver of telehealth use, especially among those with financial limitations, and patient and provider preferences for telehealth and in-person care varied broadly. 

Lastly, researchers observed that factors such as patient comfort and relationships with providers played into telehealth success, and telehealth permitted patients and providers to continue care while feeling safe from COVID-19 exposure.

Based on these insights, researchers created a set of recommendations related to advancing digital inclusion, reducing barriers to telehealth access, and building capacity for equitable telehealth delivery.

Researchers first recommended that stakeholders enhance screening for digital affordability and streamline enrollment in public benefit programs to make devices more affordable. They also suggested that stakeholders build referral partnerships with organizations that have expertise in providing digital literacy training and convene public conversations designed to improve mobile infrastructure in rural and low-income communities.

To reduce access barriers, they recommended that stakeholders conduct collaborative research on the effects of telehealth on healthcare cost, quality, and access, and implement streamlined approaches to telehealth coverage.

In pursuit of equitable telehealth delivery, the report's recommendations included developing statewide standards for technology that deliver telehealth while considering technical and inclusivity elements, supporting the translation of patient portals and communications into languages other than English, and supporting clinician training in the delivery of private and medically appropriate telehealth resources.

Lastly, researchers recommend that stakeholders collaborate with employers to promote payment models that support engagement with primary care and publish a report every three years that covers overall progress toward achieving digital health equity.

The report concluded that despite the advantages of using telehealth to ensure access to care, there are many variations in its use across populations. Thus, there are several actions stakeholders should consider taking to improve affordability, outcomes, and access.

The digital divide is a longstanding barrier to ensuring equitable access to telehealth.  

In April, Boston University and Boston Medical Center researchers reviewed the relationship between telehealth and the digital divide.

They developed a three-pronged approach for eliminating digital health inequities: create federal and state policies to operationalize telehealth infrastructure, establish national standards for healthcare access portals, and support families who adopt new care modalities.