Two Reports Detail Health Centers’ Implementation of Telehealth Visits for Underserved Patients During the COVID-19 Pandemic

The emergence of COVID-19 prompted a dramatic increase in telehealth services among health care providers seeking to offer continuity of care for patients. This major shift was supported by changes in reimbursement policies giving Federally Qualified Health Centers (FQHCs) flexibility to provide medical services remotely, including allowing the same payment rate for in-person, phone, and video visits.

In July 2020, the California Health Care Foundation responded to the move toward telehealth by launching the Connected Care Accelerator (CCA), which provided funding to 45 safety-net organizations in California. The program supported health centers in expanding their telehealth capabilities and, for 23 of these organizations, sponsored a 12-month Innovation Learning Collaborative to rapidly design, test, and share telehealth implementation solutions. Blue Shield of California Foundation and L.A. Care provided additional funding.

The Connected Care Accelerator Innovation Learning Collaborative Final Evaluation Report looks at the health centers participating in the Innovation Learning Collaborative during the pandemic. Authored by the Center for Community Health and Evaluation (CCHE), part of Kaiser Permanente Washington Health Research Institute, the report assesses changes in the health centers’ capacity to implement virtual care, the experience of health care staff in delivering telehealth, and the impact of the collaborative. The report draws on clinical utilization data from February 2019 to February 2021, including visits and unique patients by modality (clinic, phone, in-person) and interviews with health center teams in fall 2020 and spring 2021.

Led by RAND with input from CCHE’s report described above, Experiences of Health Centers in Implementing Telehealth Visits for Underserved Patients During the COVID-19 Pandemic: Results from the Connected Care Accelerator Initiative builds on previous research. It explores recent literature on telehealth implementation in safety-net settings and presents new information on the experiences of the 45 CCA health centers. The report draws from data on visit trends, interviews with health center leaders, and surveys of health center providers and staff.

Summary of Findings

• Although overall visit volumes remained about the same from the prepandemic to the pandemic study periods, the share of audio-only and video visits dramatically increased during the pandemic, particularly for behavioral health.
• Audio-only visits were the leading telehealth modality for primary care and behavioral health throughout the pandemic study period. However, at the end of the study period, audio-only visits were eclipsed by in-person visits for primary care but not behavioral health.
• The use of video visits varied substantially across health centers, particularly for behavioral health. Health centers that delivered numerous video visits and replaced audio-only visits with video visits over time had some promising common practices.
• Patients with limited English proficiency participated in a significantly lower percentage of video visits compared with the percentage of patients who typically receive primary health care services. To address disparities in access, clinics engaged in various creative solutions to address the digital divide.
• Perceptions of whether telehealth provided an acceptable level of care were relatively positive; however, there were differing views on its sustainability and its impact on equity and quality.
• Key facilitators of telehealth implementation were leadership support, patient willingness to use the technology, platforms that were easy to access and use, a sense of urgency within clinics, changes in reimbursement policy, and training opportunities for staff.