Community Health Centers Need a Telehealth Strategy, Resources to Survive

Community health centers will need a good grasp of telehealth to survive both the coronavirus pandemic and what lies beyond.

That’s the take-away from a new article in Health Affairs, which notes the lack of telehealth adoption prior to COVID-19 and outlines three steps that should be taken to bring CHCs, which serve more than 28 million underserved Americans, up to speed with connected health.

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That strategy may be crucial. While federal and state governments have taken steps to boost telehealth adoption during the ongoing pandemic, CHCs, federally qualified health centers and rural health centers have in many cases struggled to use the technology because they hadn’t laid the groundwork prior to the pandemic. Meanwhile, with the nation in the midst of an economic slump and hundreds of thousands without jobs, these health centers will likely see a surge in traffic as more and more people lose their health insurance.

The Health Affairs article, written by June Ho-Kim of Brigham and Women’s Hospital (and a primary care physician at Upham’s Corner Health Center, a FQHC) and Eesha Desai and Megan Cole of the Boston University School of Public Health, points out that only 38 percent of the nation’s 1,330 CHCs were using telehealth in 2016, and two years later that number had only jumped to 44 percent.

Of the 56 percent not using telehealth in 2018, only one in every five was giving it any thought. And of the 44 percent using telehealth at that time, roughly 70 percent were providing telemental health services and 47 percent were using it for specialist consults – and only 30 percent were using telehealth for primary care and 21 percent were offering chronic care management services.

Furthermore, CHCs faced significant barriers to adoption telehealth. The top three were lack of reimbursement – prior to COVID-19, Medicare didn’t reimburse for telehealth services at these centers and didn’t recognize them as a distant site for telehealth delivery – lack of resources and lack of training. In rural areas, meanwhile, almost 20 percent didn’t have the broadband connectivity to support telemedicine technology.

The COVID-19 emergency changed that dynamic. With the pandemic reducing in-person care and putting the onus on remote care, CHCs saw their in-person visits plunge and were forced to lay off staff, reduce hours or even close. Federal and state governments responded with a barrage of emergency measures aimed at reducing the barriers to telehealth and boosting reimbursement.

“While an important first step, policy makers cannot simply infuse more funding to CHCs and expect them to withstand the challenges of the COVID-19 era,” the article points out.

It offers three “targeted strategies” for improved telehealth adoption:

1. Mandate payment parity for all telehealth services, not only during COVID-19 but beyond.  

“Without commensurate reimbursement for telehealth, CHCs cannot maintain patient volume or make the long-term investments necessary to remain financially viable,” the article states. “A ‘ of paying CHCs a fixed payment per patient per month would give practices flexibility in how and where to treat the patient, although this may be politically and practically challenging. Meanwhile, payment parity has already been implemented and could simply be permanently codified into existing reimbursement schemes, giving providers the option to select the best mode of treatment without making financial trade-offs.”

2. Provide funding and guidance for telehealth adoption.

This includes hardware and software, broadband access and training, and ancillary systems to handle traffic on different channels, such as phone and video.

“Adding robust protocols and systems will allow for the successful implementation and scaling of telehealth,” the article states.

3. Provide support so that CHCs can reach vulnerable, underserved populations.

This would include funding for translation services and support for patients not familiar with the technology. Payers, meanwhile, should provide support for patient care navigators and waive any requirements that place geographic or original site restrictions on telehealth and that mandate audio-visual platforms.

Finally, local governments should offer mHealth devices to underserved populations and create internet hotspots and charging stations to improve access. Insurers could support these efforts with reimbursements through the Federal Communications Commission’s Lifeline program.

“COVID-19 may pose long-lasting damaging effects on CHCs and the patient populations that they serve,” Kim, Desai and Cole write. “Nonspecific federal and state funding will allow CHCs to survive; however, deliberate action is needed to enhance telehealth capacities and ensure long-term resilience.”

“By reorienting the goals for implementing telehealth, policy makers, payers, and providers can empower health centers to thrive into the future and meet the nation’s underserved patients where they are, even during the pandemic,” they conclude. “In the long run, telehealth can increase access and equity - but only if the right investments are made now to fill the gaps laid bare by COVID-19.”