Virtual care has great potential to improve rural health and health equity.

Virtual care can either serve to stretch the capabilities of understaffed rural clinics – for example, by pre-screening or triaging patients before sending them to a crowded facility – or to route excess clinical capacity from large academic medical centers to rural clinics, such as by facilitating telehealth appointments between city-based providers and patients in rural areas.

In short, telehealth can improve rural care. Which is why we sat down with Shayan Vyas, senior vice president and medical director of hospital and health system at Teladoc Health – to glean his expertise on telemedicine and rural care, both the benefits and the challenges.

Q. How can virtual care improve rural health?

A. I am enthusiastic about virtual care's potential to address rural healthcare access, and I believe it can be used to improve barriers to access in a number of ways.

It's important to remember that improving rural health is more than just increasing access to care. Improving rural health also means improving access to scarcely available specialists and subspecialists that patients may not otherwise be able to see, at least not in a timely manner. This is particularly vital for specialties like stroke or cardiology where access to a specialist via virtual care can literally save lives.

Something we've been seeing a lot of success with, specifically for addressing rural health concerns, is this concept of a "hub and spoke" model for telehealth, where hospitals and health systems can partner to bring specialist care closer to those who live in rural and underserved communities.

Rather than requiring patients to travel to a health system's hub where most specialists are – or have clinicians travel to rural clinics to see patients – we work with them to enable their clinics within rural communities with virtual care capabilities so patients may remain within their local community while still accessing specialists they would have had to travel often hours to see.

The ability to instead connect with that specialist virtually, either from home or a local provider office, can alleviate both the time and cost burden on patients and prevent burnout for the clinician as well.

Q. How can telehealth improve health equity in rural America?

A. Virtual is there and ready to care for everyone, and we need to ensure all people feel seen, heard and understood relative to their care needs.

Virtual care solutions support the pursuit of health equity by connecting members to better health through capabilities that accommodate phone-based preferences, low-bandwidth situations and that support people with physical impairments that can reduce mobility.

This might be by offering care by landline for people with visual impairment, and for communities that lack internet connectivity, or providing medically certified interpreters during a virtual visit.

Care delivered virtually should always be responsive to individual cultural beliefs and practices, preferred languages, health literacy levels, and communication needs. For example, at Teladoc Health, we believe engagement communications should be at or below the 4th grade reading level.

Q. What are the challenges standing in the way of greater success for telemedicine in rural America?

A. Limited broadband is a notable challenge for those living in rural areas, but the availability of non-video options and models like the hub-and-spoke program mentioned before are helping many overcome this barrier.

There is obviously the challenge of educating both patients and clinicians on telehealth, but I think another challenge is medical licenses and the ability to distribute the physician supply across the United States to match the demand of rural patients across the country.

Virtual options that leverage providers with multiple state licenses can better help to bring care to healthcare deserts across urban and rural America. I also think we have to make telehealth easier, more user friendly, and more exciting than the traditional in-person visit.

Reimbursement is often cited as a barrier to greater adoption of virtual care, and that could be in the form of parity or just a clear understanding of what reimbursement looks like for clinicians.

Advocacy is also a challenge – the more we can advocate for key health equity issues on both the state and federal level and work with policymakers to address persistent disparities in connectivity, access to technology and digital literacy, the better we can advance innovative solutions to expand access to care.

Twitter: @SiwickiHealthIT
Email the writer: bsiwicki@himss.org
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