The passing of the Telehealth Expansion Act of 2023 shows the federal government’s commitment to health equity, emphasizing the importance of increasing access to quality healthcare for all citizens, regardless of location or socioeconomic status.

This is a bipartisan bill recently passed in Congress that allows citizens with high-deductible health plans and health savings accounts access to telehealth and other remote care services permanently, without having to meet their minimum deductible first.

The bill makes permanent telehealth flexibilities that were first introduced in the CARES Act of 2020 in response to the COVID-19 pandemic, flexibilities that were set to expire at the end of December 2024 along with other telehealth extension provisions.

It allows for health plans and employers to cover telehealth visits for individuals with high-deductible health plans and health savings accounts, providing families with the critical flexibility that allows them to maintain access to a range of affordable virtual care services before the deductible is met.

Healthcare IT News wanted to dig deep into the new law and its promises, so we sat down with Kamala Green, social drivers of health program manager at National Government Services. National Government Services empowers federal healthcare agencies to deliver care to millions of Americans through outcomes-driven innovation. The company helps bridge the technology gap to make IT an enabler of healthcare, not an obstacle to operations, it said.

Q. Please talk about some of the important stipulations of the Telehealth Expansion Act and what it aims to do.

A. Excitingly, this bill provides us with a bigger picture of what health equity can look like as we implement it from practice into policy. It will have a significant impact on those with low incomes and those living in marginalized or rural communities. For example, low-income patients will not have to make the tough decisions of whether they should eat or get medical treatment due to their high deductible.

The expansion allows for people to start the cycle of primary care treatment and follow up on other treatment options that their doctor or primary provider has recommended for them, without having to worry about high costs, deductibles or transportation issues.

As of July 17, the Department of Health and Human Services laid out further details and stipulations to what will be covered in the bill, in addition to further insight into telehealth services in a broader sense moving forward.

One important stipulation allows federally qualified health centers and rural health clinics the ability to serve as distant site providers for behavior and mental health services, addressing the high rates of mental and behavioral health concerns after the pandemic.

HHS has also announced the removal of geographical restrictions for originating sites for non-behavioral/mental telehealth services. In doing so, patients will be able to receive care even if their provider is out of state.

Ultimately, this bill provides us the ability to look at healthcare from an outcomes-based perspective. By increasing access to telehealth services, we're able to provide healthcare to the people who need it most, while also specifically addressing health equity implications in socially marginalized communities, improving patient satisfaction, increasing access to specialty care services, and decreasing reliance on emergency departments.

Q. What impact can expanding access to telehealth services have on improving health disparities in marginalized communities?

A. Telehealth can have a tremendous impact on increasing health equity and improving health disparities in marginalized communities. However, access to telehealth services historically has been disproportionately distributed to those in marginalized communities. The Telehealth Expansion Act aims to address that disparity moving forward.

A study conducted by the House Ways and Means Committee found 91% of patients reported telehealth made it easier to get the care they needed, with the highest use of telehealth among low-income individuals.

According to the U.S. Census Bureau, more than 60 million citizens are living in rural America. Many of them are not within reasonable distance from a grocery store, nonetheless a hospital or provider for primary care.

In these rural environments, which also are experiencing healthcare workforce shortages, telehealth allows patients and their families greater access to primary care, in addition to specialty care such as behavioral and mental health services regardless of location.

Many patients in these communities also lack mobility or the funds for transportation, further emphasizing the importance of telehealth access. With telehealth, patients can receive guidance from their providers from their homes, including whether they need to come in for an in-person visit, or if telehealth visits are sufficient. This provision also helps extend healthcare access to older patients and tribal nations.

The lessons we've learned from the pandemic have spotlighted the need for continuity of medical services, and health education specifically for prevention and intervention of diabetes and tobacco cessation, and the increasing behavioral health services.

As such, it is essential to tailor solutions that fit the population of the people lacking the quality resources they deserve. Expanding and establishing permanent access to telehealth services is a great first step in providing these solutions.

Q. How important is it for the federal government to continue to increase access to high-quality healthcare via telemedicine, and why the federal government?

A. The federal government plays a key role in continuing the implementation of high-quality healthcare and health equity practices, and I'm pleased with the initiatives that have been launched thus far.

The Biden-Harris Administration’s Executive Order on Advancing Racial Equity and Support for Underserved Communities through the Federal Government (EO 13985) is strategically leading the work in health equity, which was amended this year by the current administration to address healthcare concerns and enforce health equity policies into practice.

It is imperative to have a national strategy that flows down to our state and local health departments as well as to providers to show the commitment the federal government has to the health of all its citizens.

The global pandemic showed just how important the role that the federal government plays in delivering resources and enacting policies that provide state and local governments with the funding needed to support their citizens in need.

Gaps in our medical care system showed across every racial and ethnic group during this time, which required the federal government to step in to facilitate a strategy to assist each state with the necessary deployment of resources (vaccinations, food, housing, broadband) amongst those communities, especially those that were disproportionately affected.

Not only did the federal government take ownership of facilitating these resources, they also took the responsibility of enacting policies to prevent these problems from arising in the future, such as the CARES Act and telehealth bills that followed.

To further this effort, the Centers for Medicare & Medicaid Services is currently synthesizing data around health equity that allows the federal government greater knowledge of the communities that need the most support, and how to offer that support in a way that is customized to fit their specific healthcare needs.

As opposed to providing blanket solutions to every locality, the government can use this data to understand the specific needs of a community, deploy specific resources, such as increased telemedicine and telehealth access, and get the specific health outcomes desired.

It is essential for the federal government to continue leading the way to push the health equity agenda through policy, leveraging additional funding so healthcare programs can be initiated at the state and local levels.

Q. How can the healthcare community strengthen equitable access to health services? What role does health IT play?

A. In my experience, telehealth is a powerful tool to improve patient satisfaction, improve specialty care, education, wellness and equity. This technology enables healthcare providers to ensure patients are receiving the care they need on an individual and community level.

It is critical that healthcare providers strive to maintain telehealth’s accessibility to ensure all people have easy, quick and reliable access to quality care. Telehealth also provides a window into health outcomes and trends at scale – population health can be observed to determine how best to treat people in socially marginalized communities or underserved communities, further advancing health equity.

As an industry, the healthcare sector has learned many lessons from the pandemic. It's now time to use those lessons and focus on how to improve the healthcare system and optimize patient outcomes. IT can drastically improve the health and wellness of our communities, but certain infrastructure is required to support these advantageous IT systems.

For example, telehealth services cannot function without high quality broadband access, and unfortunately, many areas of the country still lack internet access. While IT is undoubtedly an enabler of health equity, if the IT itself is inaccessible, it can worsen health disparities. Luckily, many healthcare nonprofits stepped up to build the necessary infrastructure for folks to access telehealth when needed.

Beyond the essentials, the healthcare industry must also understand that digital tools – specifically AI tools – can now maximize the value of the data providers collect via data analytics to illuminate emerging health trends, identify gaps in care and improve health outcomes.

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