Design Telehealth Initiatives to Enable Health Equity Strategies

As we have learned from delivering care during the COVID-19 pandemic, telehealth is more than a simple alternative to an in-person visit. Consumer behavior and preferences have shifted, creating an opportunity to scale virtual care solutions. Medicare now compensates most virtual visits and physician organizations continue to integrate telehealth and remote patient monitoring into their care delivery systems. But while it’s true that telehealth increases convenience for providers and patients and facilitates access to care, it also has limitations,
and health care and community stakeholders need to consider health equity to ensure that telehealth does not exacerbate disparities.  

The “digital divide” disproportionately affects people of color and low socioeconomic status. Challenges range from digital illiteracy to unreliable internet access and technology use—but
they also offer policymakers and health care and community leaders an opportunity to collaborate on solutions that fit with existing and planned quality and health equity programs during the shift to the virtual care model.  

How can policymakers and health care and community leaders work to improve technology in vulnerable rural and low-income communities?  

How can health care stakeholders improve digital literacy and access through care delivery services and services?  

Improving Access to Digital Technology 

The Federal Communications Commission (FCC) prioritizes health care providers that play a significant role in engaging vulnerable populations. In March 2021, the COVID-19

Telehealth Program added almost $250 million to programs established under the CARES Act, which prioritizes hardest-hit and low-income areas, tribal communities,
critical-access hospitals, Federally Qualified Health Centers (FQHC) and providers in rural counties.  

FQHCs provide health care services to at-risk and vulnerable patients, supporting low-income and underserved communities in urban and rural areas. Enabling digital health at FQHC facilities will advance scalability of services (regardless of a person’s ability to pay) and sliding fee discount programs, and provide comprehensive, community-based primary care services.  

Improving Digital Literacy Access and Training 

Technology solution owners and health care systems with successful virtual care models can collaborate to address digital technology, literacy and coverage in underserved populations, such as having discussions on how to prioritize use of funds. Funding can improve computer ownership in rural and low-income communities. Health systems can identify high-risk patients with low digital literacy and enlist community health workers to help these patients learn the basics of using a computer or smartphone.  

There are ongoing efforts at the federal and state levels to expand broadband availability. The FCC and other funding should consider directing efforts to widen the entry point to virtual care in the future—through alternative technologies outside the telehealth platform—to effectively integrate and facilitate a whole-person care model across vulnerable populations.

For example: 

· Digital reporting and data collection functionality.
· Community-based organization referral platforms.
· Patient outreach and education.
· Caregiver management platforms.
· Patient health information management products. 

To advance health equity and improve access to digital technology, policymakers, health systems, innovators and funders must recognize the opportunity to reassess and strengthen connections with underserved communities. While simultaneously, determining meaningful investment opportunities in technology that promote interoperability and considers community and population adoption needs.  

What are your thoughts? Share with us in the Community Forum.  

1. How does your organization align telehealth adoption strategies with health equity initiatives?  

2. Has your organization received an FCC stimulus, or is it planning to apply for round 2? If so, how will you address the digital divide?  

3. What clinical or operational challenges should stakeholders consider when working to implement digital solutions for engaging vulnerable populations?