5 Key Takeaways 

Although the swift adoption of telehealth has been heavily praised, telehealth has also endured a fair amount of criticism. Most notably, there’s the growing concern that telehealth exacerbates longstanding health disparities. These disparities often lead to poor health outcomes for underserved populations living with chronic diseases. At the same time, telehealth could very well be the solution. 


This topic was extensively discussed in Cecelia Health’s webinar held on June 23, 2021. Moderated by the company’s chief medical officer, Arnold Saperstein, MD, the webinar featured four speakers — each with significant expertise in helping health plans connect with vulnerable populations to improve health outcomes. These speakers included: 


  • Abdou Bah, Vice President of Medicare Stars and Quality Management at EmblemHealth
  • Amy Kendell, Vice President of Complex Health Solutions at CareSource
  • Sabrina Kuhn, PhD, Healthcare Executive
  • Amanda Pearsons MD, MBA, Deputy Chief Medical Officer at MetroPlus Health Plan


Below are the five key takeaways from the webinar. 


  1. Today’s digital divide is about more than the prevalence of smartphones 


Digital divide refers to the gap between those who have access to information technology and those who don’t. Lack of access to digital devices has traditionally been viewed as the reason for the digital divide. However, growing evidence reveals a majority of the general population does have access to a smartphone or digital device. 


The real reason behind the digital divide is multifaceted, primarily revolving around the individual’s physical location. Some rural areas continue to experience infrastructure problems that prevent or slow down broadband connection. Although urban areas tend to experience these problems less often, a lower income building with dilapidated, disinvested infrastructure may have the same broadband connection issues as a rural area. 


An individual’s success with telehealth may not only depend on their zip code but also their home environment. If they live with multiple people who need to use the same device, they may not be able to have a virtual visit. Further, depending on the size of their home, they may not have sufficient privacy to receive therapy or discuss intimate health details with their provider. 


Additionally, health plans have identified not only a digital divide but also a language divide in digital health solutions. Virtual care solutions often come in one or two languages, such as English and Spanish, disregarding other ethnic groups who may be using the platform. This language divide coupled with insufficient understanding of how to use telehealth in the first place can discourage patients from utilizing digital health solutions.


  1. Health plans must target and alleviate social determinants of health (SODH) barriers 


It’s well-established that SODH barriers — such as food and housing insecurity, neighborhood violence, and transportation — can negatively impact the health of vulnerable populations. In the past, health plans often depended on community-based organizations (CBOs) and healthcare providers to uncover and resolve these challenges. However, this mindset has dramatically shifted due to COVID-19 and the rise of value-based reimbursement. 


Now, many health plans are taking a more hands-on approach, including:


  • Incentivizing providers to make SDOH screening a routine part of their workflow so they can share this data with health plans and CBOs that work with members on a regular basis
  • Working with CBOs directly to conduct a health needs assessment while the CBO engages with the member (e.g., when a food bank provides food to a member)
  • Figuring out SODH solutions for local health systems
  • Directing members to SDOH solutions through mass outreach campaigns (e.g., text messaging)
  • Asking vendors, including disease management platforms, to consider SODHs in their solutions


With these strategies, health plans can adopt a more holistic view of their members and create solutions — including digital health tools — that promote greater access to equitable healthcare. 


  1. Telehealth can temporarily address common gaps in care


Sometimes, a health plan itself can be a barrier, such as when the member cannot afford to pay the copay to see a provider. Considering this, some health plans have implemented telehealth solutions that provide temporary physical and behavioral health services at no copayment.  


It’s important to note that these solutions do not create continuity of care but rather a safety net for vulnerable members who need immediate access to care. In this way, health plans can decrease the rate of non-threatening emergency room visits, which can drain revenue and adversely affect population health outcomes.


Ultimately, to support vulnerable populations, health plans will need to assess whether a member is receiving the benefits package appropriate to their health and socioeconomic situation. 


  1. Using telehealth to minimize disparities requires proper design and execution 


In the United States, African American and Hispanic communities account for a higher prevalence of chronic conditions and adverse health outcomes. Initially, many of these individuals turned to telehealth because of the COVID-19 pandemic. But is this momentum likely to continue after the pandemic ends?


Health plans will need to speak with patients from vulnerable populations to understand their motivations for using telehealth beyond COVID-19. They should also try to decipher how members feel about their telehealth experience thus far, to gauge their satisfaction level. 


In short, health plans must meet their members where they are in their healthcare journey and figure out what is important to them when it comes to using virtual solutions.  


For example, many adults juggle work and family responsibilities, but those with vulnerable backgrounds typically find it more difficult to achieve work-life balance. These individuals will be less inclined to use telehealth if it’s designed like a traditional brick and mortar setting, which tends to have limited hours of availability. 


Telehealth providers are more likely to attract vulnerable populations by offering flexible options, such as on-demand, nighttime, or weekend appointments.


Telehealth alone cannot solve health disparities. However, telehealth can help health plans directly address disparities — and their workforce might be a good place to start. By increasing the diversity of their workforce, health plans can build trust, encourage broader telehealth use, and increase health outcomes among vulnerable populations.


  1. Telehealth regulations are subject to change and may impact vulnerable populations


Due to COVID-19, policymakers have relaxed many regulations surrounding telehealth, but it’s not entirely clear how telehealth will fare in a post-COVID-19 world. Therefore, it’s vital that health plans collaborate with federal and state regulators regarding the trajectory of telehealth’s future — especially in terms of its impact on vulnerable populations. This may lead to an update in current regulations or a complete overhaul of pre-COVID-19 regulations. 


Regardless of whether these changes occur, providers will need support navigating reimbursement codes, including Z codes for SDOHs. This support may include technical assistance to educate providers on the ever-changing and complicated reimbursement landscape.


It’s becoming increasingly clear that despite mass COVID-19 vaccination, telehealth is here to stay. But whether a telehealth visit is appropriate can vary according to the situation. For example, prenatal screenings are commonly done face to face while certain children’s visits may be performed via telehealth. Ultimately, providers will need to strike a balance between leveraging telehealth and in-person visits. 


Healthcare stakeholders — such as health plans, providers, and digital solutions vendors — must pay close attention to developments in telehealth legislation to determine their influence on the digital divide and healthcare disparities that often plague vulnerable populations. 


Watch the full webinar here!