The pandemic has worsened the healthcare inequities facing many marginalized communities, including Black Americans. Telehealth offers one means of addressing disparities – but healthcare stakeholders must step up to make it sustainable and effective in closing the gaps.
The COVID-19 pandemic has strained healthcare systems across the globe and affected every patient on Earth – some, of course, more than others.
For some patients, pandemic-related disruptions have perhaps meant an elective surgery deferred or a follow-up doctor visit done through an app rather than in person. For those in historically excluded communities whose access to healthcare was already constrained, the pandemic and its cascade of healthcare disruptions, delays and barriers has been far more severe.
In the United States, the pandemic has disproportionately impacted the health of minority communities, including Black, Indigenous, Latinx and Pacific Islander Americans. According to data from the Centers for Disease Control and Prevention1, non-Hispanic Black Americans are as likely as non-Hispanic white Americans to be diagnosed with COVID-19, but are 2.6 times more likely to be hospitalized as a result and nearly 2 times more likely to die from it.
The reasons for this disparity are many and complex. Black Americans are more likely to face barriers to care, including poor transportation options, a lack of local specialist physicians and inflexible work situations that make taking time off to seek care prohibitively difficult. They are also much less likely than white Americans to have access to private health insurance (in 2019, 43.5% of non-Hispanic Black Americans were privately insured, compared to 74.7% of non-Hispanic white Americans2).
Tentative steps forward for telehealth in the U.S.
Telehealth technologies, including virtual visits and remote monitoring, offer a potential (if partial) means of addressing these disparities by reducing barriers to care. Telehealth use has increased exponentially in the U.S. since the beginning of the pandemic, fueled by policy moves lifting regulatory barriers and incenting utilization. A Clarivate survey of physicians found that at the pandemic’s outset, in the spring of 2020, 21% of U.S. physicians reported having used virtual consults to treat patients in the previous three months – up from single digits in 20193. By summer 2020, after the initial wave of infections, that figure had climbed to 80%, softening only slightly to 65% by spring 2021.
This trend has broadened receptivity to telehealth among physicians and patients alike, and shifted expectations around the healthcare experience. In a recent Clarivate survey, U.S. patients were asked how they saw their use of virtual doctor visits changing once pandemic mitigation measures have lifted. Respondents anticipated more in person visits, but saw virtual visits making up more than a quarter of consultations with doctors (26%, down from 35% in the spring of 2021) post-pandemic4.
However, many of the government, insurer and employer policies driving telehealth adoption are temporary measures that could sunset with the end of the federal Public Health Emergency, or earlier. Moreover, many patients face barriers to accessing telehealth services – for example, more than a third of Black households (36.4%) lack a computer or broadband access5. Pandemic disruptions may be making these problems worse – in a recent survey of hospital and healthcare industry leaders by Healthcare Business Insights, 92% agreed that COVID-19 had exacerbated digital inequalities for patients6.
The transportation challenge of our time
“The pandemic really highlighted the inequities that we have, both in the broader society and in healthcare delivery,” said Dr. Denise White Perkins of Detroit’s Henry Ford Health System. “When we converted the majority of our visits to virtual care at the start of the pandemic, it became immediately obvious that there were certain segments of the population we were serving that did not have equal access, whether that was knowing how to use the technology or the more upstream issues of having broadband access in their neighborhoods.”
Forty years ago, said Dr. Perkins, hospitals in Detroit gave patients cab vouchers and bus passes to ensure they could make appointments.
“Telehealth has become the new transportation challenge,” she said. “If we’re going to be delivering care across this platform, then we need to be thinking about what systems and resources and processes we need to put in place to get patients to that visit, and we need to have a diverse group of stakeholders at the table helping us to figure that out.”
Those stakeholders include healthcare payers, providers, drug and device companies, academic medical centers and governments, as well as patient advocates, community organizations and institutions. All have a vital role to play in realizing the promise of these technologies to address deeply-engrained racial and other inequities in our healthcare systems.
We have just completed a report on this topic, drawing on Clarivate and other data as well as interviews with experts from payers, providers and advocacy organizations addressing healthcare inequities facing Black Americans. You can download it here. To learn more about these issues and how companies can help make a difference, visit CEO Action for Racial Equity.
1Centers for Disease Control and Prevention, 2021. Risk for COVID-19 Infection, Hospitalization, and Death by Race/Ethnicity. [Online] Available at: https://www.cdc.gov/coronavirus/2019-ncov/covid-data/investigations-discovery/hospitalization-death-by-race-ethnicity.html [Accessed 1 December 2021]2U.S. Department of Health and Human Services Office of Minority Health, 2021. African American Health. [Online] Available at: https://www.cdc.gov/vitalsigns/aahealth/index.html [Accessed 6 October 2021]
3Clarivate, 2018-2021. Taking the Pulse U.S. 2018-2021, New York: Clarivate
4Clarivate, 2021. Cybercitizen Health U.S. 2021, New York: Clarivate
5CEO Action for Racial Equity, 2021. Closing the Digital Divide: Connecting the Disconnected. [Online] Available at: https://ceoactionracialequity.com/issues/closing-the-digital-divide/ [Accessed 6 October 2021]
6Healthcare Business Insights, 2021. 2021 Trends Analysis: HBI State of the Industry, Milwaukee: Clarivate