Every month, Stephanie Cutrer juggles multiple doctor visits to her primary care provider, therapist, and podiatrist to manage her diabetes, depression, and other health conditions. The 56-year-old Oakland resident values in-person doctor visits — but because of the dramatic recent increase in telehealth options, she can also access care through phone and video appointments.
Connecting with doctors from her home is a welcome change from the days when she called a cab or took public transportation to her many appointments. Cutrer saves time and money, and she is able to keep more of her appointments. Even when she doesn’t feel well enough to leave the house, the Zoom app on her mobile phone puts her just a tap away from her therapist.
“I can communicate with my doctor really good, and if I want her to call me, she can call me,” said Cutrer. “I can express to her what the issue is, and it just works. It really works out pretty good because I can still get what I need.”
Cutrer is one of a diverse group of Californians who participated in a study commissioned last summer by CHCF to better understand the telehealth experiences of people with low incomes.
“We have entered a new phase of telehealth,” said Diana Camacho, MPH, a CHCF senior program officer. “As the COVID-19 pandemic wanes, we are seeing a more hybrid approach to health care involving in-person visits mixed in with phone and video visits.” Since the height of the public health emergency, the number of Californians reporting a telehealth visit dropped but now is stabilizing, demonstrating that telehealth remains a significant way for patients to get health care. Nearly 61% of Californians reported a phone or video visit in 2022, down from 75% in the previous year, according to a recent CHCF Health Policy Poll.
The same survey found that Californians are using phone and video in place of in-person visits. About 4 in 10 state residents (42%) participated in a phone telehealth visit and almost 4 in 10 (39%) used a video telehealth visit. As in previous years, most Californians were satisfied with the care they received via phone and video.
According to research from RAND Corporation, telehealth is also more commonly used in behavioral health care. Sixty-three percent of behavioral health appointments were conducted by phone or video in 2022.
Telehealth Gives Patients Control
Late last year, NORC, an opinion research organization at the University of Chicago, set out to explore telehealth experiences and preferences of Californians with low incomes. NORC conducted the research by interviewing 73 individuals representative of the state’s racial, ethnic, and geographic diversity who had telehealth visits in the previous year. The interviews were conducted in English, Spanish, Cantonese, and Vietnamese from July to November 2022.
While differences in preferences and experiences emerged from the conversations, the report Telehealth Experiences and Preferences Among Californians with Low Incomes revealed commonalities and important themes. Here are some key examples:
- Californians with low incomes want telehealth to play an important role in their future care. Most interviewees said they would like to receive at least half of their care via telehealth.
- Most interviewees wanted to have an active role in choosing which type of visit (phone, video, or in-person) made the most sense for their specific health concern.
- Telehealth increases access to health care by removing many barriers, including financial costs and transportation challenges.
- Interviewees’ experiences with video visits revealed some tradeoffs. Many reported occasional audio and video connectivity issues but expressed the view that their provider was more engaged in their care in video visits.
- Telehealth helps patients build stronger relationships with providers. Participants overwhelmingly reported high levels of satisfaction and trust with care provided via phone or video.
- Telehealth visits with language-concordant providers are effective. Participants who wanted and received care in a non-English language reported high levels of satisfaction and confidence in communications with their providers.
“Telehealth has been the biggest blessing. I go in person to see my doctors like the pulmonologist when I have to take tests, but when I come back home, I’m wiped out for at least two days.”
—Heart attack survivor Jean Daino, 84
“It’s important to monitor patient experiences to ensure that all Californians have equal access to telehealth and satisfactory experiences,” said Camacho. “By listening to patients directly, we can learn about their preferences, ongoing challenges, and areas for improvement. Telehealth helps build trust between patients and providers, which enables appropriate preventive care, necessary follow-up, and generally better care.”
Timely Online Care
Jesse Beacham Grijalva Prieto, a nonbinary college student who lives in sparsely populated Humboldt County in northwestern California, has faced many challenges getting care for their mental and physical health.
Living in a remote area presents additional challenges for Prieto, who has had difficulty finding a mental health provider they feel comfortable with. Prieto gets mental health services through a mobile app made available to university students, which allows them to make an appointment with a mental health provider in minutes.
Telehealth is an important bridge to care in areas where there aren’t enough health care providers to meet the needs of the population. Humboldt is one of many counties designated a Health Professional Shortage Area — a place with insufficient numbers of primary care, dental care, or mental health care providers. Seven million Californians — mostly Latino/x, Black, or Native American — live in these shortage areas (PDF) in the Northern and Sierra region, the San Joaquin Valley, the Inland Empire, and many parts of greater Los Angeles.
It’s important to Prieto to find doctors they trust and who provide gender-affirming care. It’s also important to them to have the flexibility of being able to choose among in-person, phone, and video visits. In general, Prieto prefers video, but they have had good experiences with both types of telehealth.
“The most important thing is just feeling understood by the provider,” Prieto said.
Telehealth Has Become a Lifeline
In Riverside, Jean Daino, 84, connects with multiple doctors from her apartment in an assisted living facility. Chronic obstructive pulmonary disease causes her to have shortness of breath, frequent lung infections, and fatigue. She also battles kidney failure and recently was diagnosed with diabetes. She regularly talks by phone to her nephrologist and pulmonologist and makes in-person visits to her primary care doctor and cardiologist.
“Telehealth has been the biggest blessing,” said Daino, who recently experienced a heart attack that left her heart working at 60% capacity. “I go in person to see my doctors like the pulmonologist when I have to take tests, but when I come back home, I’m wiped out for at least two days.”
She does not want her son, a part-time high school teacher, to miss work to take her to appointments.
Daino likes it when her doctors present her with the option of an in-person or telehealth visit. “Telehealth is the best thing that’s come out of COVID.”
Implications for Health Systems and Policy
At the beginning of 2023, California pandemic-era rules became law and require phone and video visits to be reimbursed at the same rates as in-person visits. New rules from California’s Department of Health Care Services will require that Medi-Cal providers offer in-person and video visits in addition to phone appointments. These changes, coupled with the NORC report’s recommendations for policymakers, health care providers, and plans, are essential elements in the development of California telehealth policy and practices. The report advised providers to:
- Embrace phone and video telehealth services as essential.
- Ensure that patients have a choice about the type of visit they will receive.
- Integrate interpretation services, and offer phone and video visits to patients with providers who speak the patient’s primary language.
- Support telehealth use by patients with disabilities or mental health conditions, as well as those who identify as nonbinary. Telehealth can also help address local provider shortages and connect patients to providers from outside their area.
- Improve technical support; assess patients’ digital literacy, availability of devices, and broadband connection; and provide up-front assistance and education for telehealth visits (especially video visits).
Cutrer has no reservations about meeting with her health care providers via telehealth technology because it solves so many problems for her.
“I think telehealth works,” she said. “I know everything can use a little tweaking, but I don’t have problems or issues. Everything works out fine for me, so I’m pretty happy.”
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