Exploring the ATA’s New Tools to Address Telehealth Disparities

September 21, 2023 - The rise of telehealth has proved to be a double-edged sword. On the one hand, virtual care technologies have expanded much-needed healthcare access, while on the other, they have shone a harsh light on digital health inequities that can widen care gaps. Thus, there is a growing demand for support in tackling digital health disparities, and a prominent trade group is attempting to answer the call by launching new online resources.  

Numerous studies point to telehealth access barriers, noting that minority groups often cannot reap the benefits of the technology. A study published in 2022 revealed that compared to White people, Black and Hispanic people were 35 percent and 51 percent less likely to use telehealth.

Plus, location matters. A study published in 2021 showed that Medicare beneficiaries who lived in non-metro areas were less likely to report that their primary care provider offered telehealth appointments and less likely to use video or voice calls than their metro-based counterparts.

Healthcare providers and payers are working to tackle these disparities in various ways, including conducting translational research, employing interventions to close the digital divide, and addressing digital health literacy issues.

To support digital health equity efforts across the industry, the American Telemedicine Association (ATA) launched three tools earlier this week.

UNDERSTANDING THE TOOLS

The ATA CEO's Advisory Group on Using Telehealth to Eliminate Disparities and Inequities created the tools, which broadly aim to help healthcare stakeholders in deploying and assessing digital health equity interventions.

In an ATA webinar, David Smith, CEO and founder of Chicago-based advisory firm Third Horizon Strategies (THS), detailed the tools.

The first is a digital infrastructure score, a composite measure that can be used to score a community's digital infrastructure on a scale of zero to 100. Four variables feed into the score: the base accessibility or availability of a broadband connection; the existence of a device that will allow somebody to connect to that connection; the speed at which that connection performs, on average and relative to other communities; and the relative cost of data to access tools and resources through a broadband connection.

"The digital infrastructure score itself, because it sits on a composite index of zero to 100, can be used as a relative score to look at different communities across the country and really get a sense of what might be occurring within those communities," Smith said.

An interactive map allows users to see the digital infrastructure scores of various areas across the country. For example, the scores of urban metro areas in Illinois range from 80 to 90 on the scale, while more rural areas in the state tend to have scores in the 20-30 range, Smith explained.

The second tool is an Economic and Social Value-Added (ESVA) Calculator. The calculator analyzes capital and operating costs of telehealth-based clinical or social interventions, including costs associated with technology platforms and the funding necessary to provide reliable broadband connectivity.

Smith explained that the calculator provides a breakdown of the overall economic value of the interventions for four distinct stakeholder groups: hospitals, payers, the government, and corporate entities.

"This [tool] will break down the cost if we were to spread that capital cost out according to these different stakeholders on the basis of what percentage of an economic benefit they derive," he stated. "And then we identify the overall stakeholder savings and the quality-adjusted life years saved over time."

The third resource is a toolkit that includes all the tools the advisory group has released since its inception in 2021. The toolkit walks users through the newly released tools, including a breakdown of the variables and methodology for the digital infrastructure score and inputs for the ESVA calculator, Smith said.

The toolkit also provides access to the advisory group's prior reports and frameworks.

CREATING THE TOOLS

According to Ron Wyatt, MD, advisory group co-chair and founder and CEO of healthcare consultancy Achieving Equity, LLC, developing the tools required the group to examine multiple aspects of digital health equity.

"We said, let's understand the history of [healthcare disparities], and then let's understand the lives of people that we want to help to benefit from this work," he said during the webinar. "So, that means understanding the cultures of people and approaching that with some level of humility that is often, in many ways, overlooked."

This also involved understanding the long-standing lack of trust in the healthcare industry among people of color, rural populations, seniors, people with disabilities, immigrants, and LGBTQ populations and the institutional structural racism that drives digital health inequity.

Delving into these factors led the group to create tools that provide actionable insights into telehealth disparities.

The digital infrastructure score, for instance, aims to provide healthcare stakeholders with a comprehensive view of the barriers they may face when setting up telehealth programs in certain parts of the country.

"We have care deserts all throughout the country," said Yasmine Winkler, advisory group co-chair, independent director at GEHA Health, and secretary of the ATA board, during the webinar. "So, I think we were driven to get to the right solution… There are many tools that tell you about disparities in care, but there was nothing that really created that intersection with broadband access."

Further, a key hurdle in telehealth adoption is making a business case for implementing and using the technology.

Telehealth implementation could involve deploying new broadband technology, setting up devices, creating community access points for telehealth, and numerous other processes, said Kristi Henderson, DNP, advisory group co-chair and ATA board chair, in the webinar.

Measuring the value and impact of these efforts has typically only focused on the cost of deployment. The advisory group sought to change this through the creation of the calculator.

"It was, 'Okay, it's going to cost me this amount of money to deploy a diabetes program, and I'm going to impact the total cost of care for diabetes,'" said Henderson, who is also CEO at Confluent Health, a group of physical and occupational therapy companies. "That was one piece…but it was just not the full picture."

The calculator helps provide the missing link between telehealth implementation and return on investment, quantifying the cost of not implementing the intervention.

"I just think this is going to take us so much further ahead to be able to really capture the cost of us not doing this and not investing in this infrastructure," she said.

PUTTING THE TOOLS TO USE

While these tools provide an array of possibilities for enhancing digital health equity efforts, Henderson believes their primary use is in product and program development. Using the tools, stakeholders will be able to assess the communities where they want to implement telehealth interventions and better target the interventions to that community.

"The other side of this is in building the business case and budgeting and getting the capital investments needed," she said. "That calculator is absolutely critical to be able to justify it, understand [the] baseline, and understand [the] full impact so that you can scale programs that work."

Walker added that the tools could help educate and create awareness around the value of telehealth. For example, they could be used to inform lawmakers about how telehealth impacts people, what the economics of telehealth adoption and use look like, and the policies and regulations needed to support equitable telehealth use.

As healthcare stakeholders stand up and scale their telehealth efforts, it is essential that they do so through the lens of digital health equity, Wyatt stated.

Deploying telehealth in an equitable way goes beyond profit and loss statements, and the tools can help make that case as healthcare leaders work to integrate virtual care into the overarching strategic plan for their organization.  

"I hesitate to call it a business case," he said. "It really is a moral case, and that's how I would communicate it. This is the morally right thing to do."