By: Kati Moran
Prior to the COVID-19 pandemic, Federally Qualified Health Centers (FQHCs) were limited in their ability to offer telehealth to their patients, largely due to an unfavorable policy landscape.
While some health center leaders saw the promise of telehealth in improving access to care for patients, they were challenged to fully achieve that promise in the absence of permanent virtual care provisions and payment parity. This changed in March of 2020 when the COVID-19 pandemic forced health centers and other providers to immediately pivot and figure out how to care for their patients virtually.
For FQHCs, who take care of historically underserved patient populations—including the very population of people that COVID disproportionately impacted—the urgency was even more apparent. FQHCs were relying on the fee-for-service revenue that comes from patient visits; without those visits, the financial ramifications would be dire.
The loosening of provider and reimbursement restrictions, which had previously made it nearly impossible for health centers to deliver telehealth, combined with the sense of urgency caused by the pandemic, created ideal conditions for health centers to rapidly innovate and implement telehealth and other digital health capabilities.
Today, it is apparent that telehealth is not going away; retail-based, direct-to-consumer, and insurance-led telehealth technologies continue to become embedded in the healthcare landscape, making it an attractive option for savvy healthcare consumers who are looking for convenient access to care. Some patients may seek out digital health tools and, if they find their primary care teams do not provide them, they may turn to these non-traditional options—potentially disrupting continuity of care or leading to more fragmented and less culturally competent care. Furthermore, this may lead to a health care system in which more resourced patients have access to telehealth services and digital health tools, whereas historically underserved patients do not.
As digital health technologies continue to expand as mechanisms and instruments for the delivery of patient care, health center leaders must build these capabilities to ensure convenient and accessible care for their patients. Community health centers are experts at providing patient-centered and culturally competent care, and telehealth capabilities have become a necessary tool in ensuring continuity of care. Telehealth is not going away, and the adoption of these digital health tools is a key strategy for keeping health centers at the forefront of primary care innovation.
With the pandemic’s urgency behind them, many health center leaders are focused on optimizing telehealth for long-term sustainability.
They have moved on from viewing telehealth as an emergency, pandemic-era tool, and are now exploring how to leverage telehealth and other digital health tools to address key challenges and support strategic priorities at their health centers.
These include:
- Provider Recruitment and Retention
- Patient Experience
- Office Space Management
- Access to Primary, Urgent, and Specialty Care
- And more!
According to the Commonwealth Fund’s 2024 National Survey of FQHCs, 96% of health centers now offer telehealth, up from 24% in 2018. In addition, 94% of the survey’s respondents feel that telehealth has helped reach patients who would forgo care— which speaks to the immense potential of telehealth in reaching medically, socially, and behaviorally complex patients.
However, without an intentional focus on equity, this rise in digital health solutions can worsen existing health disparities. Patients may face many barriers to using digital health tools, including reliable and affordable internet, access to devices (such as smartphones, laptops, or tablets), and digital literacy skills and training.
Digital access or digital inclusion is often considered a super social determinant of health, due to its direct impact on access to health services and information, as well as its necessity in addressing other health-related social needs.
While telehealth and digital health tools have the potential to increase access to care, improve quality of care, and improve patient experience, it is often not possible for a health center to expand telehealth capabilities without an additional investment of time and resources.
For instance, Duffy Health Center, a healthcare for the homeless provider located in Hyannis, MA, has incorporated digital health innovation and equity into their strategic plan. They view telehealth as a valuable tool to reach their homeless and at-risk patient population, a patient population made up of individuals that may often be living in temporary housing or substance use treatment facilities that are far from their homes and their health center.
Duffy Health Center has assembled a multidisciplinary digital health team that meets regularly to review and discuss their progress on their digital health workplan, invested in a Digital Health Navigator to provide hands-on support to both patients and providers, and are led by a leadership team that champions digital health in words and actions.
With these focused efforts and resources, they have gradually and steadily increased their rate of video visits from 0% to 18% this year—well on their way to meeting their goal of 30% for the end of 2024. Without ongoing reimbursement for audio-only telehealth, however, this effort would not be possible nor sustainable, and many of their patients would be at risk of forgoing care or losing access to their trusted care team.
Like Duffy Health Center, many health centers are working to ensure that all patients can access telehealth. They are analyzing their telehealth utilization rates by race, ethnicity, language, and age to identify and address inequities in access to telehealth. They are calling patients before their telehealth visit to assess their comfort and offer to conduct practice telehealth visits to ensure they are prepared for their visit. They are helping patients enroll in digital literacy classes and connecting patients to community organizations and federal benefits that can provide free or discounted devices and data plans. When patients do not show up for their scheduled appointments, they call them to offer a telehealth visit for that same day.
There is much debate about the future of telehealth reimbursement. Some argue that telehealth should be reimbursed at a reduced rate than in-person care, or that audio-only telehealth should not be covered at all. Such reasons assume that telehealth is less expensive to deliver than in-person care, or that telehealth does not provide the same quality of care as in person care—an argument that has been disproven.
While this may be the case for telehealth-only providers without physical locations, it minimizes and undermines the immense work that health centers and other safety net providers must invest to ensure that their patients and communities have much-needed access to digital health services.
An intentional focus on equity means all patients can use clinically appropriate telehealth and digital health tools. It means designing policies, procedures, and programs that promote active, not passive, adoption of digital health by care teams and patients. And often, this means we need to challenge our assumptions about patients’ desires and capabilities, and we need to provide the tools and resources to support and empower our patients. As all these digital health tools and technologies proliferate, it is on health centers to envision, strategize, and implement a hybrid care delivery system by applying a health equity and patient-centered lens to guarantee that their communities are not left behind.
