Our country is facing a health care crisis. During the COVID-19 pandemic, we watched as some communities experienced skyrocketing COVID-19 cases, complications, and deaths while others had ample supplies of personal protective equipment and mass testing sites. Many of those same communities where cases climbed had little access to testing or treatment and faced serious challenges in accessing the life-saving vaccine. The pandemic certainly tested the limits of our health care system, but these inequities existed long before the COVID-19 crisis.
Communities of color, rural communities, and communities below the poverty line are among the most underserved when it comes to health care access. Financial constraints, limited access to transportation, and the inability to take time off to see a health care provider can all impede a person’s ability to access care.
Take, for example, the maternal health desert in South Side Chicago. Years of closing obstetrics and gynecology departments and entire hospitals have resulted in limited access for expectant and new mothers. This means that pregnant women must figure out where or how to get care somewhere else; and, unfortunately, too many women simply go without adequate care. Just last month, the Illinois Department of Public Health released a report illustrating the disproportionately higher rate of maternal mortality and morbidity for Black women. The review committee offered one recommendation: Increase telehealth coverage on health insurance plans.
We have been increasingly using telehealth services during the pandemic to limit doctor and patient exposure. However, as we begin to move past the pandemic and social distancing restrictions become more relaxed, we should capitalize on the momentum of telehealth technology and continue utilizing this tool to bring health care to underserved communities.
Access to quality health care services is a complex problem comprised of geographic, socio-economic, and historic factors. But as we witnessed in 2020, patients began connecting with health care providers via their laptops and cellphones with the increased expansion of telehealth, bypassing so many of the physical barriers that prevented them from managing chronic conditions and accessing preventative health services.
Telemedicine was already revolutionizing health care delivery before COVID-19, but the necessity for social distancing has only pressed the accelerator. More practitioners now offer virtual appointments, and file sharing technology is expanding. Telemedicine has the potential to fundamentally change the delivery of health care services and break down barriers to care. Telemedicine can be the great health care equalizer; but only if it is implemented equitably.
According to a 2019 Pew report, 82% of white Americans reported owning a laptop or desktop computer compared to 57% of Hispanic Americans and 58% of African Americans. Additionally, when comparing rates of broadband adoption, Black and Hispanic adults also lag behind in access to internet connection. However, when comparing the usage of mobile devices and smartphones, Black and Hispanic Americans own and use these devices at the same rate as white Americans, at around 97%. Additionally, these groups are more likely to rely on their smartphones for myriad activities, including seeking health information.[1] If we ensure that all Americans can have access to broadband internet and the technological devices needed to access telehealth, we can integrate their doctor and entire health care team into that device to help manage chronic conditions and address health inequities.
Telehealth has the potential to move us toward a preventative health model rather than a treatment-based health care system. Let’s envision a world where prevention is the norm rather than the exception. For example, congestive heart failure patients could receive a scale that sends their weight to their primary care team every morning, allowing their providers to track a patient’s progress with diet, medication, and exercise. If the patient began to show daily signs of fluid overload with increasing weight gain, the health care team could set a telehealth visit to determine whether the patient requires further intervention.
Anecdotally, I often hear stories of how telehealth is beginning to close the gaps. In fact, one story that has stuck with me during the recent public health emergency is that of a young constituent who met with me last year. This child uses a wheelchair and lives with her mother in a walk-up apartment building. Before the expansion of telehealth during COVID, she had to miss days from school; and her mother had to take time off from work to get her down the stairs, into their vehicle, and to the doctor’s office. Then, they would drive back and repeat the whole process again and again. During my visit with them, they shared what a gift the expansion of coverage of telehealth had been to them. This young lady was no longer missing substantial time from school, and her mother was able to save all the time and prep work required to get her daughter to the physician’s office. It was also easier for her to get an appointment and not have to wait for in-person availability to see a health care professional.
I am also hearing from many health care providers that there has been an increase in the number of patients who are able to keep their appointments and that patients are adhering to recommended treatment plans. I have spoken to mental health providers who rejoiced in being able to increase the number of patients that they are able to see through telehealth.
If there is a silver lining in the dark cloud of the pandemic, it is that COVID-19 has demonstrated how vital telemedicine and telehealth technologies are — especially during a public health crisis. We know that telehealth cannot replace all in-person visits. There will always be a need for face-to-face interaction with providers, but the good news is that the quality of care has not been compromised during this time of increased virtual health care, and telehealth has been proven effective.
In the 116th Congress, I introduced the Evaluating Disparities and Outcomes of Telehealth During the COVID-19 Emergency Act. Many patients and providers have benefited from the Centers for Medicare & Medicaid Services’ (CMS) relaxed regulations and report positive experiences with the technology. Telehealth also raises questions regarding utilization, cost, fraud, security, privacy, and equitable access for those left behind by the digital divide, including rural citizens, the elderly, and minority communities. It is critical that, post-pandemic, Congress and CMS develop data-driven telehealth policies that benefits all communities.
Today, we have the capacity to knock down barriers, close the health care access gap, and bring health care into people’s homes, especially folks in places that have been locked out of the system for too long. We must use this moment to build needed investments and structures so everyone can access broadband internet and the digital technologies needed for telehealth services. Let’s move forward and create a system that allows equitable health care access to all in need. We can do it — and telehealth is the tool to get us there.
[1] https://www.pewresearch.org/internet/fact-sheet/internet-broadband/?menu...
