where a primary care doctor can loop in a specialist for help on a patient ’ s case .
With physician e-consults , the patient does not have to wait for the referral , schedule and wait months for a second appointment , take additional time off of work , plan transportation or relay information between doctors . It also allows the doctor to stay at the top of a case while incorporating specialist expertise for issues in which they aren ’ t as experienced .
“ It ’ s actually bringing specialists to primary care providers ; there is no patient in the middle ,” says Gray .
Who might get left behind ?
Advocates have long believed in the power of telehealth to increase access to care for some patients , but there also is a concern that it could inadvertently widen gaps elsewhere .
Data is still emerging , but substantial racial disparities in the use of telehealth have already been observed during the pandemic . In one example at Mount Sinai Health System in New York City , data showed significantly fewer Black and Hispanic cancer patients used telehealth than the total patient population . Current racial disparities could possibly widen if health care technology is integrated without careful measurements and innovative solutions .
Adults over 65 represent a disproportionate percentage of health care spending relative to the size of the population , yet they are the group least likely to describe themselves as digitally ready . How would a digital-first approach in health care work for this group ?
“ The billion-dollar question is : What do we do to ensure that these ( policies ), once made permanent , are equitable ? That ’ s the key idea . It needs to be equitable . It shouldn ’ t be just the rich that have access ,” says Julie Bates , the associate state director of AARP California .
Bates , of Stockton , has worked in telehealth advocacy for nearly a decade . AARP California wants to see the utilization of telehealth increase in the older-adult population . Bates notes that many older adults are happy to use
technology to video chat with grandchildren or attend weekly book club meetings . She believes if most people are given the opportunity and the training to engage with technology , many , if not most , will .
“ I think it is counterproductive to say that older adults are unwilling to engage with the technology ,” says Bates . “ But there is going to be a learning curve . There is going to be a need for getting devices and getting access .”
According to research from University of Pittsburgh and Harvard Medical
School , groups less likely to have digital access are 85 or older , widowed , Black or Hispanic , enrolled in Medicaid , have a disability , or have a high school education or less . Many of these groups are already at risk of experiencing increased health disparities .
“ Even in a state as high-tech as California is , there are still significant segments of our state that don ’ t have access to high-speed internet . Even in the Bay Area ,” says Bates .
These issues need to be addressed in tandem with telehealth policy in order to bridge the digital divide . There
are a number of possible solutions to explore : Turning broadband into a public utility , government-led tech education initiatives and accessible technology design such as including display accomodations for low-vision users are just a few ideas .
“ What comes first , the chicken or the egg ?” asks Bates . “ Do we do a digital-first delivery model before we have high-speed internet to every home and everyone has access to a smart device ? Or do we ensure those things first and then move ? Or is it a hybrid ? How do we ensure that people don ’ t get left behind ?”
Will telehealth gains remain ?
The pandemic is ongoing , and the story of telehealth is still developing . The latest pandemic health emergency renewal issued by the Department of Health and Human Services in January is set to expire this month . The temporary telehealth policy waivers are expected to continue as long as the declaration is active .
In the meantime , there are a number of ways telehealth is being adopted a la carte long term . The Centers for Medicare & Medicaid Services has added a number of new telehealth codes for reimbursement . In December 2020 , Assemblywoman Cecilia Aguiar-Curry introduced Assembly Bill 32 seeking to make current telehealth flexibilities permanent under state law .
Whatever happens in the future , it ’ s clear that building equity into the plan now will be critical . There are risks that need to be measured and monitored , but those gaps can turn into opportunities for more innovation with the right mindset .
“ We do not want to stop just because it ’ s not perfect ,” says Bates . “ We keep moving forward because , for the majority of people , it is going to be beneficial and it ’ s going to be useful .”
Eva Roethler is a freelance writer and the former special sections editor of Comstock ’ s . On Twitter @ EvaRoethler .
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