HHS: Video Visit Use Less Likely Among Non-White, Older Americans

The highest rates of telehealth visits were among those with government-sponsored insurance, Black individuals, and those older than 65, according to a new federal report. These groups also had higher proportions of audio-only visits as compared to their counterparts.

Released by the Assistant Secretary for Planning and Evaluation, which advises the Department of Health and Human Services secretary, the report is based on an analysis of the Census Bureau's Household Pulse Survey conducted weekly. Researchers used survey data from April 14 to Oct. 11, 2021, to assess overall rates of telehealth use.

A total of 808,368 adults across all 50 states and Washington, D.C., responded to the survey.

About 670,155 adults answered the question on telehealth use, of which 23.1 percent reported having used virtual visit services within the previous four weeks. Among adults with a child in the house, 19.7 percent said that the child had used telehealth services in the prior month.

Overall, researchers observed a modest decline in telehealth use for both adults and children over the year, though usage rates remained far above pre-pandemic levels.

When broken down by demographics, survey data shows that telehealth utilization was lowest among the uninsured (9.4 percent), individuals ages 18 and 24 years (17.6 percent), and those residing in the Midwest (19.0 percent).

It was highest among those with Medicaid (29.3 percent), Medicare (27.4 percent), Black respondents (26.8 percent), and those earning less than $25,000 (26.7 percent).

But the type of telehealth modality these groups used varied widely.

Researchers used survey data from July to October 2021 to examine the telehealth modality used. They found that the subgroups with the lowest overall rates of telehealth use participated in video visits more often than audio-only visits.

For example, White respondents reported having an overall telehealth use rate of 21.1 percent but had a higher proportion of video visits (61.9 percent) than audio-only (38.1percent). On the other hand, 26.8 percent of Black respondents overall said they used telehealth in the month prior, but this population had a higher proportion of audio-only visits (46.4 percent) than White respondents.  

The report also noted high proportions of video telehealth visits among those between 18 and 24 years (72.5 percent), college graduates (67.4 percent), and those with private health insurance (65.9 percent).

Further, compared to White, high school graduate and younger respondents, video telehealth visits were less likely among Latino (50.7 percent), Asian (51.3 percent), and Black respondents (53.6 percent), as well as among those without a high school diploma (38.1 percent) and those 65 years and older (43.5 percent).

"The disparities evident in our results suggest new approaches beyond those strategies implemented during the pandemic will be needed to ensure equitable access to telehealth, particularly video-enabled services," the report authors concluded.

As government agencies consider how to make telehealth use more equitable, they should take into account "patient preferences, the content of services and frequency of visits, technology access, and quality of care," they wrote.

Already, states are taking these differences in telehealth use into account. Washington and Florida recently solidified audio-only telehealth legislation to help reduce gaps in access to virtual care.

At the federal level, the Permanency for Audio-Only Telehealth Act was introduced in December 2020 to expand Medicare coverage for audio-only phone visits. It was referred to the Subcommittee on Health last May.