Telehealth is the future of equitable healthcare delivery. Digital healthcare, or telehealth, is not simply a COVID-19 phenomenon but a necessary tool to close gaps in health disparities. During the COVID-19 Public Health Emergency (PHE), both the federal government and states alike made revolutionary changes to telemedicine policies in order to preserve access to healthcare services. This led to a substantial increase in utilization of telehealth services and demonstrated telehealth’s potential to address several of the longstanding health inequities faced by Black Americans, including poor access to primary care, mental health and culturally competent care.

While longstanding health inequities—particularly for the Black community—are exacerbated more than ever during the COVID-19 pandemic, this moment presents a once-in-a-generation opportunity to reinvent American healthcare as equitable healthcare.

Telehealth usage during the PHE

Before COVID-19 reached much of the country, telehealth visits were already becoming a vital means to receive care. As early as April 2020, virtual visits accounted for 13% of all medical claims for privately insured individuals in the US compared to 0.15% the year before. Similarly, among Medicare beneficiaries, telehealth utilization increased from 13,000 beneficiaries per week pre-pandemic to nearly 1.7 million during the last week of April 2020. The drastic increase was due in large part to the flexibilities precipitated by the PHE.

Prior to the PHE, Medicare reimbursed for telehealth services on a very limited basis: When the beneficiary was in a designated rural facility (known as geographic eligibility) and when they traveled to a designated facility (known as originating site) for the service. During the PHE, the Centers for Medicare & Medicaid Service (CMS) expanded access to Medicare telehealth services via temporary waivers in order to decrease the risk of exposure for beneficiaries and contain the spread of COVID-19. On a temporary and emergency basis, the geographic eligibility and originating site restrictions have been removed, allowing Medicare reimbursement for telehealth services across the country and including the patient’s places of residence. The temporary waivers also expanded the range of providers who can provide telehealth services. These waivers will expire at the end of the PHE if legislative action is not taken to make them permanent.

As telehealth emerged as a lifeline for millions during the pandemic, it also elevated the issue of equity as many of the disparities seen in traditional medicine have also been seen in telehealth. Over the course of the pandemic even when the motivation to use telehealth services has been high, disparities in telehealth utilization have remained as millions of low-income Americans lack the devices, broadband, and digital literacy required to take part. For example, a study assessing the sociodemographic factors associated with telehealth use for ambulatory care visits during the COVID-19 pandemic found that older patients, Asian patients, and non-English speaking patients had lower rates of telehealth use, and that when patients did use telehealth, older patients, female patients, and Black, Latinx, and poorer patients had less video use. As expected, another study found a statistically significant association between telehealth use and technology access: Patients residing in a neighborhood with a high rate of internet access were more likely to choose video visits than patients in neighborhoods with low internet access. This highlights the importance of an equity-focused approach to telehealth expansion- mere expansion is not enough. Equitable telehealth expansion must also encompass digital literacy and broadband/device access.

More data on telehealth usage, adoption, and outcomes is needed to understand impacts to Black patients and other marginalized communities. We know historically marginalized Black communities remain segregated from access to consistent, culturally competent, and comprehensive care. Expanded telehealth services can offer a significant and clinically meaningful path towards advancing Black community health.  Given that over 90% of Black Americans live in non-rural areas, it’s clear that previous telehealth restrictions and practitioner limitations severely hindered equitable expansion.

Call to Action 

Preliminary data has illustrated the positive effects of removing barriers like geographic eligibility requirements and originating site restrictions. Removal of these inequitable barriers during the PHE has made telehealth available to patients in both rural and urban settings across the country and has allowed them to access telehealth services from the home or wherever they are located. Advocacy for permanence of these waivers helps confirm that patients do not lose access to telehealth services at the end of the PHE. While dozens of bills have been introduced to extend telehealth services, if legislation is not passed prior to the PHE, Medicare patients risk a “telehealth cliff” which will result in immediate loss of access and further exacerbate racial disparities. In July 2021,430 organizations including CEO Action for Racial Equity (CEOARE) joined American Telemedicine Association (ATA) in urging Congress to advance permanent telehealth reform so patients aren’t abruptly cut off from telehealth services when the temporary waivers expire.

Building equity into COVID-19 temporary federal telehealth expansion policies can improve Black communities’ access to healthcare and combat existing disparities. CEOARE is a diverse business-led coalition with a unified mission: to identify, develop, and promote scalable and sustainable public policies and corporate engagement strategies that address systemic racism, social injustice and improve societal well-being. By removing federal barriers to access, affordability and quality for providers and Black patients, we foresee a sustainable path for historically marginalized communities and all healthcare beneficiaries alike. We stand with ATA and many others in support of telehealth legislation and regulations that enable equitable administration of services and digital health solutions that will mitigate disparities in the healthcare system. We urge that these tactics be assessed with a health equity lens, advocating for long-term policy solutions that expand access for all racially-diverse communities.

Lack of equitable access to care is a roadblock for Black patients. Expanding access to telehealth presents a meaningful opportunity to alleviate disparities, gain cost-efficiencies, and improve patient trust.