A research study on telehealth use in Massachusetts since the onset of the COVID-19 pandemic identifies disparities in telehealth usage and makes recommendations on how to address them.
The report, from the Department of Population Medicine at the Harvard Pilgrim Health Care Institute, a Harvard Medical School affiliate, found that seniors, children and people who live in rural areas were less likely to use telehealth during the pandemic. Telehealth use was also lower in communities where fewer households have home internet access. Not having a usual source of primary care was a barrier to using any telehealth.
The study, which was funded by the Massachusetts Association of Health Plans (MAHP), was led by Alon Peltz, M.D., M.B.A., M.H.S., and researchers from the Department of Population Medicine in collaboration with the Massachusetts Health Quality Partners (MHQP). MAHP’s board of directors has prioritized closing health equity gaps as a major initiative of the organization. This report is the first in a series of steps that the association will undertake to provide analysis, recommendations, and engagement of the healthcare community on ways to close identified gaps in the delivery and coverage of healthcare to the Commonwealth’s residents.
Combining analyses of data from more than 1.8 million patients and over 35 hours of interviews with patients, providers, and community leaders, the study aimed to answer two key questions: how has telehealth use varied across populations and geographies, and what are the facilitators and barriers to equitable access to telehealth.
The report found that telehealth greatly enabled access to primary, chronic disease and behavioral health care during the COVID-19 pandemic. However, uptake of telehealth was uneven across geographies with less use in rural areas and in lower socioeconomic status communities, although this difference was subtle for some visit types. People experiencing language barriers and financial hardships associated with costs of internet and mobile devices experienced lower telehealth access. Lower quality experiences with telehealth were associated with gaps in broadband infrastructure, digital affordability and in the usability of technological platforms.
“This study highlights how critically important telehealth has been to sustaining access to care during the pandemic while also shedding light on inequities in access across populations,” said Peltz, assistant professor of population medicine at Harvard Medical School, in a statement. “We hope these findings will inform actions that health plans, providers, and policymakers can undertake to help support higher quality and more equitable access to telehealth across the Commonwealth.”
The report’s recommendations include 1) activities to advance digital inclusion across the Commonwealth, such as screening members for unmet digital affordability needs; 2) ways to eliminate structural and financial barriers to telehealth access, including continuing to provide access to telehealth and adopting simplified approaches to telehealth coverage; and 3) activities to help build system capacity to enable more inclusive delivery of care, including supporting the creation of statewide technical, language translation, and inclusivity standards for technological platforms used for delivering telehealth.
"MHQP is proud to have contributed to this important work," said Nathalie McIntosh, MHQP's senior director of programs and research, in a statement. "This report deepens our understanding of the current barriers to telehealth access and the critical role that primary care plays in facilitating that access. Anything health plans and policymakers can do to support equitable telehealth access, including encouraging people to have a primary care provider, would go a long way to mitigating disparities."
