Latest / Becker’s Payer Issues Podcast / Closing the Rural Telehealth Gap in Chronic Care with Sarah Adkins

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Closing the Rural Telehealth Gap in Chronic Care with Sarah Adkins · Becker’s Payer Issues Podcast

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  - GLP ones, Medicare Advantage Headwinds, a Medicaid landscape
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  - that looks different
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  - every quarter.
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  - Their leadership right now means making durable decisions
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  - in an environment that keeps moving, and the
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  - organizations pulling ahead are the ones that stopped
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  - waiting for stability
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  - before acting.
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  - Becker's fifth annual fall payer issues roundtable convenes
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  - more than 500
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  - executive level attendees
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  - and 70 plus speakers November second and third
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  - at the Swiss Hotel Chicago.
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  - Two days of senior level dialogue on affordability,
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  - benefit design, value based care, and the strategies
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  - shaping how care gets financed
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  - and delivered, featuring a celebrity keynote from pro
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  - football hall of famer, Emmitt Smith. Agenda and
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  - registration at beckerspayer.com.
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  - Click events in the upper right.
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  - Hi, everyone. This is Elizabeth Cassello with the
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  - Becker's Payer Issues podcast.
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  - I'm excited today to be joined by Sarah
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  - Atkins,
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  - director of public policy with the Elevance Health
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  - Public Policy Institute.
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  - Sarah, thank you so much for joining us
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  - today. Hey. Thanks for having me here today,
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  - Liz. I'm excited
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  - to talk to you about the topic at
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  - hand.
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  - Of course. We're gonna go into some really
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  - great research, that came out of the institute
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  - pretty recently. But before we do that, Sarah,
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  - do you wanna give an overview of your
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  - background and your role at Elevance Health?
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  - Absolutely.
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  - So I have been with Elevance Health and
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  - the Public Policy Institute for about five years
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  - now. Elevance
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  - Health's the the Public Policy Institute, just a
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  - quick note to to tell you a little
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  - bit about the approach we have here. We,
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  - study what's happening across the health care system
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  - and translate those insights into evidence that help
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  - shape smarter health policy, essentially.
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  - Our work helps policymakers
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  - and health care leaders make more informed decisions
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  - about improving care and affordability.
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  - As far as my background, I've spent really
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  - the entirety of my career working in the
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  - health care sector across all different representing all
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  - different factions. Most recently, obviously, with the payers,
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  - but I've worked with provider groups. I've, worked
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  - with patient groups over the years. So I
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  - have kind of a a the good fortune
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  - of having worked across the entire site the
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  - entire industry to kind of understand from a
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  - holistic perspective,
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  - how the parts work.
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  - So with the research we're gonna touch on
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  - today, I would love to hear some of
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  - your main takeaways,
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  - in regards to telehealth and specifically the gap
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  - in telehealth uptake between rural and nonrural
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  - populations.
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  - Sure.
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  - Yeah. I would say that the clearest takeaway
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  - is that, since the initial surge in use
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  - during the COVID nineteen
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  - pandemic,
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  - telehealth remains part of, chronic conditions care, but
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  - rural communities are not using it at the
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  - same rate as nonrural communities.
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  - Across 11,500,000
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  - members and 15 chronic conditions,
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  - seven point five percent of visits among members
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  - live in nonrural areas,
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  - and those were are are living in nonrural
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  - areas were delivered through telehealth compared with four
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  - point six percent among members living in rural
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  - areas.
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  - For example, from 2022 to 2025,
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  - telehealth generally accounted for about five to eight
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  - percent of chronic condition visits in nonrural populations
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  - versus roughly three to five percent in rural
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  - populations depending on the insurance type.
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  - Really, these findings are important because telehealth is
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  - often viewed as a way to overcome barriers
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  - to accessing
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  - health care in rural areas
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  - because of things like provider shortages, travel time,
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  - and lack of public transportation.
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  - But based on our findings, members in rural
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  - areas are still using telehealth less.
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  - To touch on this a little bit with
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  - the pandemic era flexibilities
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  - and everything,
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  - and this study spans 2021 and ended in
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  - 2025.
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  - So while most conditions had a spike and
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  - then a decline,
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  - dietary counseling and surveillance, which had to do
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  - with its connection to obesity management, and that's
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  - why that was studied, had a less pronounced
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  - form of that. So could you explain why
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  - you think that might be?
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  - Sure. So the study itself did not test
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  - the reason for this pattern,
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  - but one hypothesis is that the persistence of
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  - telehealth
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  - for dietary counseling and surveillance may reflect growing
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  - attention
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  - broadly to obesity management and GLP one uptake
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  - generally during the study period you mentioned.
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  - The growth in volume for dietary counseling and
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  - surveillance services was true for in person visits
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  - during that period as well for obesity management.
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  - Yeah. I think it's really interesting to see
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  - that trend with everything we're seeing in the
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  - GLP one space right now. And then another
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  - condition that was specifically mentioned in the report
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  - was obstructive sleep apnea, and it's higher telehealth
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  - use relative to some other observed chronic conditions,
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  - even with the rural population too. So,
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  - the highest percentage of telehealth visits overall was
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  - among non rural commercial members for obstructive sleep
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  - apnea at fourteen point three percent, followed by
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  - non rural Medicaid members for the same condition
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  - at twelve point seven percent. So was that
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  - surprising to you at all?
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  - I would say it was notable, although not
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  - necessarily
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  - surprising.
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  - Obstructive sleep apnea may be particularly
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  - compatible with virtual follow-up because portions of ongoing
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  - management can involve
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  - reviewing symptoms, discussing adherence, evaluating response to treatment,
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  - and reviewing the data all virtually. And these
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  - these don't necessarily require a physical exam.
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  - And similarly, sleep studies,
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  - to diagnose sleep apnea have increased increasingly shifted
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  - from the office to home based studies. And
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  - so it would make sense that the follow-up
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  - activities could also occur virtually.
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  - That said, the study was to describe was
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  - really developed to describe utilization patterns, not to
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  - determine why one condition had higher telehealth use
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  - than another. So we can really only hypothesize
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  - as to what caused the higher rates. I
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  - would say that remain what remains striking
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  - is that even for obstructive sleep apnea,
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  - the condition with the highest telehealth rate that
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  - we looked at, the same differences persisted geographically.
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  - Rural populations still use telehealth less than their
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  - nonrural counterparts, and that reinforces that broader conclusion
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  - that we talked about that there are barriers
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  - to
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  - or preferences against accessing
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  - telehealth in rural areas that aren't as present
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  - in nonrural areas.
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  - One thing that the study noted was it
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  - excludes behavioral health conditions and members with cancer
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  - or organ transplant history. So
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  - if those populations were included, how could you
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  - foresee
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  - everything changing, especially when it comes for rural
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  - areas, if you think there would be a
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  - substantial change?
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  - Sure. A couple a couple of things there
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  - are happening. So including behavioral health conditions
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  - would likely raise the overall share of care
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  - delivered through telehealth because we know that behavioral
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  - health care has been one of the most
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  - established applications for virtual care. The paper specifically
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  - excluded behavioral health because telehealth use in that
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  - field has already been extensively studied. And the
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  - literature that we looked at does tell us
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  - that similar to these findings related to physical
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  - health, there is less telehealth utilization in rural
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  - areas for behavioral health conditions as compared to
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  - utilization in non rural areas.
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  - And then moving over and talking a little
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  - bit about members or patients with cancer or
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  - history of transplant,
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  - that could change the findings in in sort
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  - of a different way. These individuals,
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  - have greater clinical complexity,
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  - more frequent care needs, and a greater need
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  - for physical examinations, lab testing, and other kinds
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  - of things that happen in an in person
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  - modality.
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  - And telehealth may be useful for some selected
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  - follow ups,
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  - but we do think that their needs fundamentally
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  - are different from other chronic conditions and wouldn't
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  - it really wouldn't have been appropriate to aggregate
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  - them into our results.
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  - I see. Yeah. That makes sense. And at
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  - the end of the report, there were a
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  - couple of high level recommendations, and I'm just
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  - saying this directly from the report. It called
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  - for broader investments in digital infrastructure,
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  - and that was beyond telehealth access policies alone.
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  - So what could those investments
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  - look like?
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  - They could include both physical infrastructure and practical
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  - support for patients.
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  - On the infrastructure
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  - side, that could mean expanding reliable high speed
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  - broadband and cellular coverage coverage in rural communities,
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  - improving affordability for broadband access, and ensuring that
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  - patients have access to the actual devices that
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  - can be used for telehealth.
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  - On the support side, it could include
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  - digital literacy assistance,
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  - help actually setting up and testing technology,
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  - and technical support before and after appointments,
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  - language access services, and and education in general
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  - on when and how to use telehealth.
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  - Again, the broader point here is that coverage
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  - and reimbursement policies are necessary to promote telehealth
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  - use, but they may not be sufficient. Individuals
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  - have to obtain a stable connection, afford a
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  - device,
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  - and navigate the platform, and also find a
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  - private place actually to conduct the visit.
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  - So this podcast is primarily for payer executives,
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  - but other health care leaders too may be
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  - listening. So what advice do you have or
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  - any sort of final takeaways in regards to
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  - this research for that audience?
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  - The first takeaway
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  - is that offering telehealth does not necessarily guarantee
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  - consistent uptake of the services across health plan
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  - members.
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  - Leaders should be considering measuring adoption
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  - by geography,
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  - coverage type, condition, and socioeconomic
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  - characteristics to identify where eligible members are not
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  - using the services at the rates that we
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  - would expect.
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  - Secondly, telehealth strategies should be tailored rather than
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  - uniform.
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  - The report
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  - found meaningful variation
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  - by condition and insurance types.
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  - For example, Medicaid members had comparatively high telehealth
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  - use for obesity and dietary counseling,
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  - and those populations may require different clinical models,
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  - outreach, and support.
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  - And overall, I would say telehealth should be
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  - viewed as as one tool to improve access,
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  - continuity,
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  - and quality outcomes for members.
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  - Well, Sarah, thank you so much for taking
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  - the time to chat with us today. Thank
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  - you, Liz. It was a pleasure to be
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  - here. Of course. And to our listeners, if
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  - you'd like to hear more podcasts from Becker's
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  - Healthcare, you can visit beckershospitalreview.com.
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  - Thank you.