As the national response to COVID-19 continues, telehealth has taken root as a powerful tool in clinical care delivery. Further, telehealth stands to serve as a critical driver of healthcare equity and access for historically marginalized and underserved populations. This policy paper reviews how COVID-19 has impacted access to care for underserved populations, and how telehealth can be used now and in the future to help ensure access and equity.
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EXECUTIVE SUMMARY
The first U.S. case of COVID-19 was identified on January 20, 2020 [1]. In just 4 months, over 1.6 million cases have been confirmed across the U.S., with 94,558 of cases in California [2, 3]. Strategic public health measures, including social/physical distancing and home confinement, have been the key method of mitigating the risk of SARS-CoV-2 spread, the novel coronavirus that causes COVID-19. As a result of the novel coronavirus, patients were suddenly no longer able to pursue clinical care in healthcare settings as they once did. To minimize potential exposure and transmission to others, patients are foregoing needed care and essential monitoring of chronic diseases. Providers are scrambling, doing their best to shift to caring for patients at a distance, switching to telehealth-based triaging, scheduling the majority of their visits as video or phone visits, and encouraging the use of mail-order pharmacy services. Healthcare systems are confronted with the need to effectively continue to provide high-quality patient care and ensure adequate access while safeguarding the health of patients and healthcare workers during this pandemic. Telehealth offers a multitude of technologies to deliver virtual care through medical, health, and education services. It increases access to care by expanding options for patients to connect with providers. Telehealth offers a rapid response way of achieving continued primary care, while concurrently minimizing non-urgent patient flow into emergency departments, hospitals, and clinics; a necessary precaution to safeguard the safety and well-being of our essential medical workers. Telehealth services, which have enabled the continued provision of care for patients in rural and underserved communities and patients pre-pandemic, have expanded to become the primary method to screen for and manage COVID-19 related illness in the outpatient setting. The sudden and unexpected demand for telehealth has faced the dated nature of current regulations, and staggering absence of critical infrastructure and reimbursement to allow broad and sustained expansion. Short and long-term solutions are needed to improve public health and health access. This brief examines the effects of the COVID-19 pandemic on access to care for vulnerable populations and offers policy recommendations to ensure continued access to high-quality care for all patients through telehealth. By building a foundation for widespread and inclusive telehealth implementation, policymakers can ensure our healthcare workforce is able to meet the needs of all patients, especially those residing in linguistically and medically underserved communities.