Telehealth Access Disparities In COVID-19 Virtual Care Boom

While the use of telehealth has grown among all employer-sponsored health plan members since the onset of COVID-19, individuals in affluent and/or urban areas accessed virtual care at higher rates, according to a new RAND Corporation study that raises concerns for worsening disparities in care utilization.

Researchers analyzed insurance claims from over 6 million Americans who had employer-sponsored health plans from January 2019 through July 2020. Overall, the sample represented approximately 200 employers spanning across all 50 states.

The study found that the rate of in-person medical appointments declined by almost 50 percent at the onset of COVID-19, spurring a 20-fold increase in telehealth utilization. While virtual care helped accommodate some of the appointments that would have otherwise been missed or postponed, telemedicine did not fully offset the decline in care utilization.

The increase in telemedicine was most significant among members in counties with low poverty levels. Specifically, beneficiaries in counties with low poverty levels had about 48 telehealth visits per 10,000 people, compared to 15 per 10,000 people in high poverty areas.

Additionally, the researchers found that virtual care utilization was greater in metropolitan areas among employer-sponsored health plan beneficiaries. Urban areas had approximately 50 visits per 10,000 people, compared to rural areas with about 31 telemedicine visits per 10,000 people.

Jonathan Cantor, RAND policy researcher and lead author of the study, noted that this research is an important step in understanding telehealth utilization trends as COVID-19 progresses.

"Given our findings, policymakers should consider increasing efforts to reach populations that are deferring in-office care and not replacing it with telehealth visits," Cantor said in a press release.

The RAND study also revealed that adults were more likely to access virtual care compared to children aged 12 and younger, with about 65 visits per 10,000 adults compared to about 50 visits per 10,000 children. This gap in telehealth utilization shows the need for efforts directed at increasing pediatric virtual care.

"More intensive training for parents and pediatricians about telehealth, as well as efforts to address barriers to children's access to telemedicine, may be necessary," Cantor said. 

The report authors noted that as the COVID-19 vaccine is distributed and more people seek in-person care, it is unknown whether the current rates of telehealth utilization and virtual care access disparities will remain the same. Additionally, the future of telehealth policy is unclear.

"Policymakers should continue to expand reimbursement for telehealth services and also update clinical guidelines to encourage healthcare practitioners to use telehealth," the report authors wrote. "Given the results, policymakers should make a more concerted effort to reach populations that are deferring in-office care and not replacing it with telehealth visits."

However, supplementing in-person care with virtual care is sometimes impossible for people in rural areas due to connectivity issues. To help mitigate the divide in telehealth utilization among Americans in rural and urban areas, HHS announced an $8 million investment to launch the Telehealth Broadband Pilot (TBT), a three-year pilot program set to improve connectivity in rural areas of Michigan, Alaska, West Virginia, and Texas.

"HHS has made it a priority to transform rural healthcare, including through innovations like telehealth, where we've seen many years' worth of progress in just the past year," former HHS Deputy Secretary Eric Hargan said in a press release at the time of the announcement.

"As someone who hails from rural America, supporting delivery of care in the most remote parts of America, like Alaska, is a personal passion of mine, and telehealth is a crucial part of that work. This telehealth pilot program is part of the Rural Action Plan that HHS launched this past year, which lays out a path forward to coordinate agency efforts to transform and improve rural health care in tangible ways," Hargan continued.