By Cecilia Oregón, Executive Director, Kaiser Permanente Institute for Health Policy.
The following was published on www.aboutkaiserpermanente.org in January of 2023.
Once considered a luxury, high-speed internet is now a necessity. People need reliable online access to connect to essential resources, including employment, education, finances, and — increasingly — health care.
And yet, not everyone has the ability or wherewithal to get online. This is a high-tech amplification of the inequality that has troubled America throughout its history. As our nation expands its reliance on the internet to access health care, as well as social and economic resources, this digital divide can lead directly to inequality in health outcomes.
To prevent this, we need public policies that aim for digital equity: Everyone should have the access, tools, and knowledge they need to get online. We also need policies that ensure everyone who wants and needs it can access virtual health care.
Pandemic-era policy makes telehealth more accessible
During the COVID-19 pandemic, an unprecedented number of people in the U.S. have received routine care away from traditional settings. For example, Kaiser Permanente, which was at the forefront of building virtual care capacity prior to the pandemic, delivered over 28 million telehealth visits in 2021 as our members sought care while staying safe at home. After an initial peak in 2020, telehealth use in 2021 settled at a level 38 times higher than before the pandemic, according to consulting firm McKinsey & Company.
Increased adoption of telehealth has resulted from strong demand, favorable consumer perception, and public and private investments. Congressional action also helped drive increases, allowing the Centers for Medicare & Medicaid Services to remove geographic restrictions so more patients could have virtual visits. CMS also increased the types of services Medicare covers and ensured more providers were eligible to offer telehealth to their patients.
Importantly, CMS also began covering phone-based visits for Medicare beneficiaries. This change was key to expanding access for many people, especially Black and Latino populations who often face “digital redlining,” when internet companies underinvest in providing service to communities that have lower incomes, resulting in lower-quality, less affordable broadband services.
State-level policymakers also have taken steps to increase telehealth adoption. They helped ensure Medicaid coverage for phone-based care and developed multistate licensure agreements, allowing people to access a wider variety of providers across state lines.
In late 2022, Congress extended policies, but many expire after 2024. State-level policymakers also must determine the next steps.
Meanwhile, increasing access to high-speed internet continues to be a challenge for our nation. People living in rural areas and those who have lower incomes, in both rural and urban areas, remain less likely to have home broadband or own a smartphone, tablet, or computer.
The billions of dollars for broadband expansion Congress passed in the Infrastructure Investment and Jobs Act was a promising step but also just the beginning.
Policymakers must take further action
To ensure continued access to telehealth, Congress should make key pandemic-era telehealth policies permanent. They should support access to phone-based care, while working to expand digital access.
Lawmakers should also continue supporting research and the development of standards to improve healthcare quality measures. Quality measures help ensure that all care, including care provided in a virtual setting, is high-quality and equitable.
While they are working on those policies, lawmakers should work toward the broader goal of digital equity. This includes bolstering basic internet infrastructure and advancing policies to make internet access and internet-connected devices more affordable.
New policies should also help ensure everyone has the knowledge and support needed to navigate the online world. The ability to navigate is critical to enabling full access to and participation in an increasingly digital society where people need reliable high-speed internet to apply for jobs, access online education and financial resources, and more. This makes digital equity a key element of social health — the nonmedical factors that significantly influence health outcomes.
If we want better health outcomes for all, we need to work to create digital equity and make expanded telehealth policies permanent to give more Americans access to much needed care.
Learn more about digital equity and public policy by watching our December 2022 forum with leading experts.