The COVID-19 pandemic has required patients, healthcare providers, and governments to reimagine how care might be delivered at home, and has revealed opportunities to potentially improve outcomes, reduce costs, and improve patient experience. Telehealthcare adoption1 remains much higher than prepandemic levels (14–17 percent of visits, compared with approximately 1 percent in February 2020), but adoption hasn’t been uniform across clinical conditions, age groups, geographical locations, and types of insurance.2
Using national claims data,3 we estimate that more than 50 million in-person visits per year could be converted to virtual or telemedicine visits if adoption were extended equally across patient segments. In general, patient segments with limited access to in-person care (for example, those in rural counties and those with lower incomes) have relatively fewer virtual visits. While many believe virtual care can improve access for the underserved, the current imbalance in usage suggests that US healthcare stakeholders could consider designing virtual-care models that address structural barriers so that virtual care is more widely accessible.
In the following exhibits, we examine which patient segments are currently underserved by virtual care and why, and offer considerations for healthcare stakeholders regarding ways they might extend access.
More than 50 million in-person visits per year could be converted to virtual or telemedicine visits if adoption were extended equally across patient segments.
Virtual-care adoption is highest for behavioral-health specialties and lowest for procedural specialties
Virtual-care adoption is four percentage points higher in urban areas when compared with rural areas
Virtual care is being adopted at a lower rate in areas where the median income is lower than the national median
Virtual-care adoption is six percentage points higher with payers other than Medicare
The factors that appear to matter in accessing virtual care seem to be location, median income, and type of payer.
Although virtual healthcare is seen as a boon by many patients,4 its potential to mitigate healthcare differences by improving access and convenience may be currently underutilized. Structural barriers continue to affect patients’ access to all forms of care, including virtual care. The factors that appear to matter in accessing virtual care seem to be location, median income, and type of payer.
There is tremendous potential to improve access to virtual care across all patient cohorts. A few opportunities include the following:
- Address differences in uptake by income. Addressing gaps in technology, awareness, and trust may be necessary. More people than ever have access to cell phones but with variable smartphone and data access. Offering low-data-usage options, including text messages and phone calls, may help to reach those patients.
- Address differences in uptake by location. Solutions might include kiosks for increasing awareness, support, and setup guidance for less experienced digital users and community health workers trained to set up virtual care during at-home visits.
- Address differences in uptake by payer. Waiving copayments and otherwise incentivizing care models for aging or under-adopting populations may help here. Building capabilities for multidisciplinary and multilingual teams in virtual settings (multiple virtual rooms, co-consulting sessions, etcetera), creating specialized virtual-care workflows for specific populations, and generally shaping the future of culturally competent and patient-centric virtual care could all encourage adoption among those whose circumstances make the leap to virtual care less straightforward.
Virtual care is a key element in the future of healthcare delivery in the United States, as shown by its continued adoption and ever-increasing consumer acceptance. Stakeholders (payers, providers, not-for-profit organizations, governments, etcetera) should be thoughtful in building and expanding this mode of care delivery to ensure that the new ecosystem is inclusive and accessible for all—especially those underserved by the traditional US healthcare systems.