Telehealth in care deserts: Helping to overcome barriers created by location, costs, or social stigma

Expansion of virtual care: Patient acceptance and comfort

There is no denying that telehealth is here to stay. When the COVID-19 pandemic forced an expansion of and reliance on virtual care, the size of the U.S. telehealth market rose from $11.23 billion in 2019 to $17.9 billion in 2020. Although initial projected growth rates since that time have slowed and been revised down from nearly 60% to just under 23%, market experts are still projecting a $149.7 billion telehealth industry by 2030.

Heading down to the local hospital for several types of specialty and follow-up care is no longer a reality for many people and “no longer a profitable service line post-pandemic,” explains Matt Sullivan, a solution thought leader at Wolters Kluwer, Health, who specializes in virtual care and digital health solutions. Many providers have had to “cut margin because traveling nurses have become too expensive. So, you’ve seen a lot of hospitals shut down service lines that have to be replaced with options at greater distances away from patients.”

With the growing need and commonality of virtual care has come a growing acceptance of it: A 2022 systemic review of patient satisfaction surveys shows upwards of 80% satisfaction – in many studies over 90%  – with virtual care visits.

“The fact that telehealth is coming into acceptance just at the right time is not really a surprise,” says Sullivan. “Patients like that they don’t have to go into a physical setting for all appointments.”

Telehealth is especially effective and preferred in scenarios such as:

  • Hybrid model care, in which follow-up appointments for an initial in-person evaluation or physical exam are all done remotely. 
  • Skin conditions and similar concerns in which taking pictures of physical symptoms and uploading them is easy to do through telehealth services.
  • Mental health services, which Sullivan notes, have proven the most “durable” type of virtual care visit.
  • What Sullivan describes as “less traditional, single condition programs” dedicated to helping patients connect to prescribers for specific treatments, like weight-loss medications.

All of these scenarios are “becoming more accepted in the patients’ minds as a viable way of getting care, prescriptions, or treatment for conditions,” Sullivan says.

When there is hesitation on the part of patients to engage in virtual care, concerns tend to center around the quality of the relationship with their provider, he notes. “It’s not a technology divide, it’s a trust and relationship divide. Patients definitely want to feel they have a relationship with their clinician, so some may put slightly higher value on in-person care. A lot of these care models are hybrid. So, the same doctor you see in person might also deliver care virtually, which is ideal. On the provider side, they are facing the dynamic of physician burnout and nursing shortages, while on the patient side, there is the dynamic of aging populations and more people with chronic diseases. Sometimes it’s easier for both to facilitate those relationships through telehealth.”

Pandemic’s impact on virtual care services

Prior to the COVID-19 pandemic, many remote areas were already reliant on virtual care services, Sullivan says, but the pandemic accelerated the pace at which the technology became more accessible, and the concept of regular virtual care visits became more acceptable to both patients and clinicians.

He cites the example of Indian Health Service (IHS), a federal program that provides health services to native communities. IHS has “always been doing telehealth because the closest specialists are often five or six hours away” from community care centers, Sullivan explains. “But in the original world view, the patient had to drive two hours to come to the hospital to sit on one of their computers to telehealth in to a specialist who was five hours away. Now the patient can do it from home.” 

Even though telemedicine was available prior to the pandemic, it was offered in very limited situations, even in areas and to populations with inconsistent access to care. That, Sullivan explains, is because insurance rarely reimbursed the service. Post-pandemic, telemedicine services are reimbursed, usually in full, so health providers are far more willing to devote their time to virtual appointments.

The U.S. Congress has approved flexible coverage for telehealth services for Medicare and Medicaid patients through 2024.

How has telehealth affected rural and urban healthcare deserts?

Telehealth can be a game changer for patients living in so-called medical or healthcare deserts, areas where gaining access to healthcare is a challenge. It is a classification that is given to roughly 80% of U.S. counties comprising 30 million people. Prior to the pandemic, while mortality rates in the U.S. decreased overall for adults aged 25-64, those in rural healthcare deserts saw mortality rates increase 12%.

But Sullivan says, it isn’t always distance from health centers and hospitals that creates these deserts.

“It’s not just the rural setting. There are similar challenges and a lot more healthcare deserts emerging in deeply urban areas,” he says. 

Healthcare deserts develop out of two compounding challenges. While the lack of nearby quality care facilities and access to transportation are the more often cited issues, affordability also creates a divide.

Even with telehealth as an option, “access to broadband internet can be a major challenge for the very rural and the very urban dense,” Sullivan says. “In some instances, to string a single mile of fiber optic cable can cost upwards of $1 million, which can leave remote communities without access. In some urban setting options to broadband wired networks might be limited, but they typically have better cellular broadband coverage.” Maintaining broadband and cell service is essential to opening care accessibility in medical deserts.

Overcoming barriers to care access

The immediacy, ease, and accessibility of digital services have made it easier for some patients to initiate care for conditions or disease states with a stigma that previously prevented them from pursuing in-person care. Most notably: mental health care.

Sullivan cites a few key reasons why mental health services have thrived in the virtual care setting: “There’s a huge shortage of mental health providers. And if you suffer from a mental health condition, it might be more difficult to seek out these services in person.  Whereas texting on a mobile app or a video chat is much easier.”

Conditions that carry a societal stigma, real or perceived, can be as difficult a barrier to care as accessibility and affordability, he notes. Stigma or the “general inertia” that can be created by any number of conditions can be overcome by the ease and lower impact of a telehealth appointment. 

Accelerating telehealth success through integration of educational content

As patients in care deserts become increasingly reliant on telehealth for greater portions of their care, Sullivan also stresses the importance of providing patients with quality information on their treatments and wellness regimens so they can make smart choices and manage their care from home between provider visits.

It’s vital that telehealth providers have quality content resources within their technology to help clinicians support patient engagement and ongoing wellness “even if they’re not in the room with them,” Sullivan says. To that end, he has worked with Wolters Kluwer to develop UpToDate® Digital Architect, an integrated consumer education content suite for digital health that is “able to support telehealth providers in ensuring they can provide engaging, impactful information to their patients.”

When a digital health service has integrated educational materials that patients can easily access and trust, it goes a long way toward promoting better treatment adherence and building stronger patient-provider relationships, even virtually. Sullivan cites recent patient surveys that reveal:

  • 80% of patients said that if they were to receive patient education, they would be more satisfied with their care.
  • 68% reported that receiving patient education would make them more likely to return to that healthcare provider.

“In both in-person and virtual settings, the information patients need to answer their questions might barely be presented during the appointment,” Sullivan says. “Let’s face it, there’s so little time with the provider, no matter what the setting is. You need information you can trust after-the-fact, whether it’s a piece of paper printed out for you by the nurse, or a QR code that you scan, or a link in your text message.”

Regardless of patient’s age, geographical location, socio-economic or personal background, clickable links to health education from a trusted provider tend to be easier for them to use and more likely to elicit follow-through after a telehealth appointment, Sullivan notes.

“It’s a really powerful tool to put in people’s hands,” he says.

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