Telehealth – What Are We Not Thinking Enough About?

In 1962, Elroy Jetson had a telehealth visit from his home.

In 2019, 10% of people in the U.S. had used telehealth at least once. As of April 2020, surveys show 20% of people in the U.S. have had a telehealth visit. Telehealth is definitely having a moment. It isn’t hard to find articles saying the rapid uptake of telehealth because of current coronavirus distancing requirements will cause a lasting shift toward online care. If federal and state regulatory changes stay in place, reimbursement for providers is stable and cost-sharing for patients is reasonable, telehealth may very well be used by more and more people in the coming years.

What Are We Not Thinking Enough About?

1) Systemic inequities make widespread telehealth adoption difficult at best

Athena Cross, in The Technological Divide and Inequities in Health, explains, “as the health care system runs toward technological innovation, it is important not only to note the digital divide, but also the historical injustice in health that may inhibit adoption and participation by our most vulnerable and marginalized communities.”

We like to think that everyone has access to health care, and telehealth means a patient is simply having a video call with their existing health care provider. That isn’t what is happening right now. (Later this week we will write more on how #BigWillWin…)

2) Telehealth works better for some services than others

Childhood vaccine orders are down significantly, and diagnostics used to screen and monitor cancer (such as Pap smears and colonoscopies) have dropped dramatically these past few months, as these services are nearly impossible to deliver virtually. On the other hand, claims data is showing more than 50% of mental health visits were delivered via telehealth in the last week of March.

3) Telehealth today is favoring infrastructure over communities

A core promise of telehealth is improved access. But we are not thinking enough about how communities – not just patients, but also community providers and organizations, may be left behind if large corporations hire contract health practitioners who live hundreds or thousands of miles away to deliver “care” at the press of a button. How might local communities be worse off if there is no health care provider in their area? Or if health care providers don’t have race or ethnicity or culture or language or geography, etc. in common with the patients they are serving?

Will the “solution” of telehealth leave people better off? It seems we need to do significantly more thinking and balancing of priorities before we make massive policy and reimbursement changes to support this modality.