Agencies invest in a future of more equitable, accessible telehealth

As remote work transformed American offices during the COVID-19 pandemic, so too did telemedicine for the country’s healthcare system. When physical accessibility was the primary barrier to treatment, virtual healthcare was put to its greatest test.

Now, providers anticipate a future where telehealth is not a novelty but rather ubiquitous. The Health Resources and Services Administration, within the Health and Human Services Department, is positioning itself for the transition.

Home-based healthcare is nothing new, and as HHS Deputy Secretary Andrea Palm said at the National Telehealth Conference sponsored by HHS, it evolved with technology. From telephones that replaced home visits by doctors to radios transmitting to clinics on ships, telehealth continues that history.

HHS agencies saw demand for virtual services boom during COVID-19

In March 2020, the Centers for Disease Control and Prevention launched the Coronavirus Self-Checker bot to help people determine when to seek testing or medical care. Rochelle Walensky, CDC director and administrator of the Agency for Toxic Substances and Disease Registry, said that by April 2022 there had been more than 62 million visits to the bot worldwide and more than 28 million needed interactions.

Medicare’s virtual patient visits also boomed from fewer than 1 million in 2019 to more than 52 million in 2020. HHS launched Telehealth.HHS.gov as a bilingual, one-stop shop for patients and providers, with guides for rural and Native American communities that may have limited or nonexistent care. But the largest increase in Medicare telehealth visits concerned behavioral health, with white and urban beneficiaries using these services at higher rates than their Black and rural counterparts, said Meena Seshamani, deputy administrator and director for the Centers for Medicare and Medicaid Services.

Those with unstable internet and technological difficulties struggle using telehealth platforms. These are the same people most likely in need of access if they are elderly, remote or in under-resourced areas. Miriam Delphin-Rittmon, assistant secretary for mental health and substance use at the Substance Abuse and Mental Health Services Administration, said this called for regulatory flexibilities.

In 2020, the Drug Enforcement Administration issued temporary permissions to prescribe methadone and buprenorphine for opioid treatment patients without in-person visits. SAMHSA also allowed audio-only and non-HIPAA-compliant technology, and released a 2021 telehealth guidebook for mental illness treatment.

“Expanding broadband access, how we think about cultural competency and level of comfort with technologies — these are all things that we must consider as technologies are developed, as they’re evaluated and as they’re implemented, so that we can make sure that they deliver on the promise of advancing equity and really driving improvements in our healthcare system,” Seshamani said.

Connectivity, coordination and policy can help make telehealth accessible

As patients return to in-person medical visits, many still want virtual options. That requires dedicated resources and maintaining permissions once the federal public emergency declaration ends, which HHS agencies have relied on to expand telehealth. Congress extended Medicare telehealth coverage for 151 days after the emergency ends, while the Bipartisan Infrastructure Deal included $65 billion to expand broadband internet access to rural and lower-income users.

“But beyond the 63 million people on Medicare, I think this conversation is also important because due to its magnitude, market size … what happens in the Medicare program has ripple effects across the whole ecosystem,” Seshamani said. “Where we are making telehealth payments permanent for behavioral health is something that will have ripple effects throughout the system because we pay for one in five healthcare dollars. We pay for $970 billion in claims each year.”

The CDC prioritized telehealth-focused research to assess short- and long-term impacts on access to care, care quality, outcomes and costs, equity, and workforce burnout, Walensky said. She noted that telehealth also compliments electronic health record systems. Thirty-one telehealth activities are currently underway and 17 more are planned for 2023.

However, expansion will also take state licensing coordination — for mental health, in particular, said Carole Johnson, Administrator, Health Resources and Services Administration.

“In fact, it’s a place where we have seen a lot of interest at HRSA in our licensure portability projects and how states are working together to expand access to healthcare providers, knowing that demand for behavioral health services continues to grow,” Johnson said.