When state and federal policymakers created new flexibilities for health care providers to be reimbursed for telehealth services during the COVID-19 pandemic, there was a rapid adoption of telehealth services. There was also considerable new research on telehealth’s impact. A recent evidence review summarized that in-person and telehealth delivery of services generally yield similar outcomes. Few studies, however, have evaluated how telehealth delivery impacts different population groups.
While telehealth can support increased access to care for individuals who experience transportation barriers to in-person appointments, recent research points to inequities in the rates of telehealth being offered and used. Groups that are more likely to experience barriers to accessing telehealth include older adults, people of color, low-income individuals, and people with disabilities. Some of these barriers may include lack of access to affordable high-speed internet, limited access to computers and smartphones, and digital literacy gaps. The modalities (types) of telehealth services offered — such as live video or audio-only (telephone) — impacts which groups are more likely to access these services. A 2023 analysis of U.S. Census data reported that individuals of color were less likely to use video-based telehealth services as compared with white individuals, and instead were more likely to use audio-only telehealth.
What does the telehealth coverage landscape look like today?
Telehealth policies continue to be examined and refined at the federal and state levels. After the COVID-19 public health emergency ended, the U.S. Department of Health and Human Services made some telehealth flexibilities permanent for Medicare, while other temporary telehealth benefits have been extended through the end of 2024. Similarly, many states established permanent telehealth policies after temporarily expanding Medicaid coverage to include telehealth services during the public health emergency. These policies vary by state, and many states are currently redefining which services and types of telehealth are eligible for coverage under Medicaid. Additionally, some states passed “payment parity” laws requiring that in-person and telehealth service delivery are reimbursed at the same rate.
Why is this important?
Federal and state policymakers have access to a growing body of evidence on the impact of telehealth services, which can inform telehealth policy development. As federal and state telehealth policies are updated, policymakers, providers, and health plans will need to understand how to use telehealth services to address health equity goals and best meet the needs of individuals who may experience barriers to health care access.
What resources can support refining telehealth programs to advance equitable access to care?
Health care providers, policymakers, and health plans can look to the following Evidence-to-Action resource summaries to better understand the emerging evidence on how telehealth impacts access to care and find tools that support use of telehealth to address health equity priorities.
- Telehealth Outcomes and Impact on Care Delivery: A Review of Evidence – This report summarizes the evidence on outcomes for patients participating in in-person versus telehealth delivery of different services, including different modalities like telephone and video. The report also describes the level of evidence on telehealth for different diseases and categories of care.
- Assessing the Impact of Medicaid Telehealth Policy Change on Equitable Access to Telehealth Services in North Carolina – This evaluation of access to telehealth in North Carolina Medicaid and Children’s Health Insurance Program summarized state policy actions to increase access to telehealth services and invest in telehealth infrastructure, and reported on persistent racial disparities in use of telehealth after these policies were implemented. The authors suggest different strategies to increase equitable access to telehealth, such as establishing remote technology hubs and addressing implicit bias among health care providers.
- The Role of Human-Centered Design in Healthcare Innovation: a Digital Health Equity Case Study – This case study details how a health system used human-centered design to address disparities in access to telehealth services, including through collaboration with patients and stakeholders.
- Telemedicine for Health Equity Toolkit – This toolkit, designed for safety-net health systems, offers practical guidance to improve telemedicine interventions to be more equitable for diverse populations, including those with low incomes.
- Equity in Telehealth: Toolkit for Telehealth Providers – This toolkit includes a set of tools for providers delivering telehealth services to older adults to improve health equity, including by addressing the physical, cognitive, linguistic, and cultural differences within and among this group.
