Fostering accessible healthcare practices across modalities
By Allyson Livingstone | March 30, 2023
While social advocates may be pushing the needle forward in workplaces and community spaces, the idea of equity in medical care is just that — an idea.
COVID-19 and the resultant widespread adoption of telehealth, especially by people of color, led many to hope virtual care might be an equalizer that revolutionizes healthcare. In the past few years, telehealth has helped many marginalized groups access care — but has it been better care?
For example, more patients of color suffer from chronic conditions than their white counterparts, and virtual care was an efficient tool for them to conveniently check in with their providers for medication-related questions and other concerns when making it to an in-person visit was challenging. For many, it remains a challenge to see a provider face to face, even as pandemic-related restrictions ease. Telehealth can continue to address these challenges, if deployed properly in a healthcare ecosystem that is truly supportive for marginalized groups.
Research by athenahealth analyzed telehealth usage from 2019 to 2022 and found that disparities persist despite the relative increase in access for some groups . Telehealth usage among Black and Hispanic patients was higher than for white patients, but not with a single consistent provider . In fact, Hispanic patients who saw a single provider for all their appointments were 8% less likely to use any telehealth, and Black patients in this category were 12% less likely to adopt telehealth than comparable white patients. In addition, rural and low-income patients used telehealth less frequently. These findings are a wake-up call for the medical community to look past technology as a one-stop solution that will make healthcare equitable and address the wide range of complex factors that lead to health disparities.
Encounters that break down challenges to access
Telehealth alone cannot fix the relationships between systems of healthcare and patients of color — not w hen trust deficits arise from historical experiences of systemic oppression. We need to create spaces in healthcare that feel relevant to all the communities they serve. Setting time aside to have thoughtful, reassuring conversations about patients’ social conditions can go a long way. For that, providers need to be trained on implicit bias, systemic racism, and delivering care in a culturally competent way — to everyone. The onus is on providers to create an environment — in-person or virtual — that helps patients feel comfortable.
Despite these challenges, virtual care can offer new tools to make healthcare more accessible. For example, providers could easily have a translator on the line, even if one may not always be available on site. And family members or other caregivers could be included as well. Telehealth visits, under current reimbursement rules, could be audio-only if that is what is available to patients.
And telehealth can be a great tool for connecting marginalized and lower-income patients to primary care — perhaps asking about a primary care physician could be a standard question at the end of every visit. Clinicians can also educate these patients about the value of primary care and understand what qualities they are seeking in a provider. Helping patients feel more comfortable with the healthcare system can make it more likely that patients follow up in-person when recommended. Telehealth can be an entry point to deeper patient engagement.
Tailoring interactions, be they in-person or virtual, in such a way that people who are excluded from healthcare feel safe and connected — that’s the way good medicine is supposed to work. To seamlessly deliver care in this inclusive manner, clinicians need the support of technology that frees them up from their time-consuming administrative burden. And patients need supportive federal, state, and payer policies that make it possible for them to access quality care in whatever way is best for them.
Outreach efforts that change the narrative
Practices should also market their services in ways that are tailored to particular communities. LGBTQIA+ patients, for instance, may feel disconnected from the health system. Practices ’ outreach should make clear that clinicians and staff will address them by their correct gender pronouns and understand their specific concerns with respect to sexual health or gender-affirming care. These can be basic, profound, yet inconsistently met needs for this group. When advertising their services, practices should ensure they are highlighting values of diversity, equity, inclusion, and belonging.
For low-income and rural patients who may not easily be able to take time off work to travel and receive in-person care, virtual care can be a game-changer. But are we doing enough to make telehealth accessible for these patients? Not only do practices and providers need to offer telehealth, but they also need to communicate the benefits to patients, make the technology user-friendly, and take steps to understand what might make patients reluctant to use it.
Beyond that, payers need to continue to cover telehealth at the same level as in-person visits, and governments need to ensure that broadband and wi-fi services are available and affordable. Only once the healthcare system demonstrates genuine understanding of the tangible needs of underrepresented groups can communication and outreach succeed.
There is no one-size-fits-all approach to make healthcare more equitable. Telehealth is impacted by the same economic, cultural, and political issues that make in-person care challenging for certain patients. Health inequities stem from historic and ongoing privilege and oppression that healthcare cannot fix singlehandedly. But I believe athenahealth is uniquely positioned to contribute to the conversation — working with practices, providers, and payers to understand the root causes of inequity and improve the healthcare ecosystem accordingly. Every stakeholder in healthcare shares the responsibility of creating a model that offers truly equitable healthcare for all.
Allyson Livingstone is athenahealth's executive director of diversity and inclusion.