OPINION

Telemedicine can address historic structural inequities

Telemedicine is proving to be a potent tool in providing underserved communities with better access to health care.

Margo Jarvis takes part in video teleconference at Cohen Veterans Network, Fayetteville, N.C., on April 22, 2020. Since the pandemic began, the organization has pivoted its mental health services to telehealth at its 15 clinics across the United States. Brynn Anderson/Associated Press

America’s response to the coronavirus pandemic is showing that we can begin to address racism’s impact on Americans’ health by changing how we access primary care —and telemedicine is pointing the way.

The pandemic underscores deep health care inequities resulting from decades of structural racism and, as a result, COVID-19 kills Black and brown Americans at much higher rates than white Americans. Residents of low-income communities, many of whom are essential workers, face greater impediments to health care access than those with more means. Many can’t easily take time off from work, drive to doctors’ offices, or line up child care in order to make in-person appointments; they risk being fired and having their families go hungry.

Through its flexibility and low time commitment, telehealth gives fast, convenient access to care. By expanding access, it also promotes health equity and has proved effective and useful for those in underserved communities. But in order to get the most out of the advantages it confers, we must maximize access to telemedicine. This includes educating people in underserved urban and rural communities about telehealth and digital literacy, and providing patients and providers with the tablets, smartphones, remote monitoring equipment, and — critically — Internet access to close what’s become a yawning digital divide.

Social determinants of health — which underpin and drive health care inequities — point to why Black and brown Americans experience higher rates of chronic conditions such as cardiovascular disease and diabetes, two of the medical conditions that put people at higher risk for COVID-19 complications and even death.

With the physical distancing required during the pandemic, telemedicine is proving to be a potent tool in providing underserved and under-resourced communities better access to both primary care and critical support services. Through virtual visits, people of color are finding it easier to gain access to the full range of health care that a patient can and should receive in their doctor’s office, including medical, behavioral health, pharmacy, social support, and even dental and optometry services.

In fact, according to a recent Pew Research Center study, Black Americans have been more likely than white people to use telehealth during the pandemic. What’s more, data we gathered by surveying over 2,500 of the Commonwealth’s health center patients in 2020 reveal that 93 percent of them — who overwhelming represent communities of color — rate their experience with telehealth as “good’' or “excellent,” with 50 percent of Asian, 49 percent of Latino/Hispanic, and 42 percent of Black Americans wanting to continue with telemedicine for urgent care post-pandemic.

This patient data is promising. As the Pew Research study also suggests, leveraging a broad range of telehealth tools post-pandemic could have a major impact on reducing health care disparities. This can be achieved by putting telemedicine and in-patient visits on equal footing, both in terms of payment, and by ensuring that care is provided using the same multidisciplinary, team-based approach that goes beyond addressing the physical health needs of patients. Massachusetts’ willingness to pay for virtual visits at the same rate as in-person visits made it possible for the state’s largest insurer, Blue Cross Blue Shield, to process 38,000 claims per day by May 2020, up from 200 per day, pre-pandemic, and for clinicians at the Mass General Brigham health care system to conduct 1 million telehealth visits between March and July, compared with 1,200 to 1,500 a month pre-pandemic. It is a model that should be adopted on a nationwide basis.

Government leaders and technology partners are critical to building on this momentum. They must work to close the digital divide that prevents underserved urban and rural communities alike from gaining access to connected devices and broadband that make telehealth visits possible. By investing in telemedicine programs and building the infrastructure necessary for expanding our broadband network, we can realize the full promise of this new health care delivery technology to address historic structural inequities.

Christina Severin, president and CEO of Community Care Cooperative, and Michael Curry, president and CEO of the Massachusetts League of Community Health Centers, are cofounders of the Massachusetts FQHC Telehealth Consortium.

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