Is telehealth exacerbating health inequities?

It has been widely reported that telehealth utilization increased dramatically during the COVID-19 pandemic. In fact, MedeAnalytics health plan customers saw up to a five-fold increase in telehealth utilization from the first quarter of 2020 to the second quarter of 2020 for the employer groups they served. The increased reliance on telehealth during the pandemic was partially driven by patient desire for virtual visits during the peak of the pandemic, but more importantly was accelerated by regulatory changes. These included allowing audio-only virtual visits, allowing treatment from providers across state lines and, critically, rules for payment parity between virtual and in-person visits. Although not all these rules have been made permanent at this point, many provider organizations have started re-organizing staffing models around a more virtual future, particularly for behavioral health treatments.

While the share of telehealth visits for physical health matters has dropped since 2020, more than a third of behavioral health visits remain virtual. Virtual care for behavioral health visits has several benefits:

• Behavioral health care appointments are often frequent and recur for at least six months; virtual care helps reduce time away from work and other obligations for the patient.
• There has long been a shortage of behavioral health providers; virtual care can help eliminate geographic care deserts.
• Patients may be more comfortable with or open to receiving care from the safety of home. Additionally, seeing (or hearing) patients in their home setting may allow the provider to have greater insight into the patient’s life and potentially provide more appropriate support.

While employer groups are pleased that virtual care has finally taken a foothold, they must be aware of how access to telemedicine interacts with employee diversity, equity and inclusion (DEI) programs. It is also unclear what the long-term impact of telehealth will be on care quality—something providers, health plans, and plan sponsors must all watch with a critical eye.

Using data to support DEI goals

According to the 2021 Willis Towers Watson Best Practices in Health Care Survey, over three-quarters of employers say they are prioritizing programs to advance DEI initiatives. As a key part of this priority, employers should also be working with their health plans to ensure their benefits are aligned with DEI goals. That could look like:

1. Measuring key KPIs to uncover any intergroup variation
   Overlaying cost and utilization data from their health plans with external social determinants of health data publicly available from the CDC—or with the employer’s own race, income, and family size data—can allow the employer to identify any high-level variation in average cost, utilization or disease prevalence between advantaged and disadvantaged groups.
2. Drilling into program specifics
   For telehealth access in particular, lack of access to video devices, limited internet access and varying language skills can be common barriers to service. Employers and health plans can work together to identify any patterns in lower utilization by geographic region, job class or wage bands.
3. Turn data into action with targeted communication
   If an employer does uncover undesirable variation in telehealth use, there are several steps that can be taken to improve access. These strategies include targeting communication to underutilizing groups, perhaps in conjunction with Employee Resource Groups associated with the affected population; deploying benefits messaging in additional languages where applicable; and considering employee cost share reduction to address any financial barriers to accessing virtual care.

Data can be difficult to understand—and even more challenging to apply. That’s why health plans and providers need a powerful analytics solution to break through the noise and extract valuable insights. The greater our understanding of telehealth trends and use cases, the more we can design tailored programs that lead to better patient engagement and outcomes.