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HRSA Foresees Telehealth Growth

Appearing on an expert panel Tuesday, HRSA health economist Ching Ching Claire Lin discussed findings from health center data about telehealth adoption across the country.
Appearing on an expert panel last month, HRSA health economist Ching Ching Claire Lin discussed findings from health center data about telehealth adoption across the country. "The use is still the exception rather than the rule," noted one panelist, but more than half of all states have passed laws favorable to adoption.

Multiple factors are slowing the adoption of telehealth technology as a means of delivering specialized care, HRSA's Office of Planning, Analysis, and Evaluation has found.

But demand for behavioral and substance misuse treatment, in particular -- especially in rural areas where care is scarce – is likely to increase use among health centers in the years ahead, according to the newly published analysis in the journal Health Affairs.

The paper examines metrics from the 2016 Uniform Data System. A panel of researchers speaking at the National Press Club on Dec. 4 agreed that the technology faces similar hurdles in the private sector. Among them:       

  • Older patients have been slower to acclimate to the technology;
  • Lower income households without ready access to  computers and mobile devices are adapting at lower rates;
  • Concerns about data security continue to linger;
  • And insurers – both public and private -- differ on which remote services they will cover.

Telehealth, broadly, includes patient portals, clinician-patient videoconferencing, remote diagnostics and records-forwarding.

HRSA's Claire Lin discussed the findings of OPAE's report -- Telehealth in Health Centers: Key Adoption Factors, Barriers HRSA Exit Disclaimer -- published this week in the journal's December 2018 issue.

The authors concluded that federal health centers are more likely to use telehealth, relative to other providers of primary care. In 2016, nearly 40 percent of health centers were using the technology – compared to only about 15 percent of family physicians.

"The difference might imply that health centers have a greater need for using telehealth or are in a better position to adopt it," Lin noted, adding that rural clinics are leading the sector. "Given that many health centers reported that they were in the process of implementing telehealth or exploring the possibility of doing so, an increase in the adoption rate is likely in the future."

Panelists on Tuesday said they expect that trend to continue -- with regional clinician shortages, the opioid crisis and demand from an aging population adding pressure to health systems.

Percentage of Telehealth Use Among Health Centers
Type of Service Percent

Any Use

Mental Health Care 49.3
Specialty Care 23.5
Primary Care 24.9
Managing Patients with Chronic Conditions 21.2
Oral Health Care 4.0
Other Services 22.0
More Than One Type of Service 27.9

Cost, reimbursement and technical issues are major barriers, the authors of the OPAE analysis noted. Access to broadband continues to be a challenge in some jurisdictions, but not one frequently cited by federal health centers, panelists said.

In particular, federal Medicaid program policies in place within individual states influence any health center's investment in telehealth: Policies promoting live video and store-and-forwarding of data were associated with a greater likelihood of adoption.

Reimbursement also is a key determinant. Specifically, state-level Medicaid policies were significantly associated with health centers' implementation. Medicaid policy barriers also potentially explain the negative association between telehealth adoption and the proportion of Medicaid patients at health centers.

"Our findings suggest that telehealth adoption is driven in part by the need to improve access, with health centers in rural areas more likely to invest in telehealth and use it for mental health care, compared to those in urban areas," the publication reports. 

Rural health centers also were more likely to provide remote mental health care, reflecting both a shortage of providers and the need to use telehealth for care coordination.

But the increasing number of health centers designated as Patient Centered Medical Homes portends well for the spread of the technology, the authors suggest.

As medical homes often require integration of behavioral health and primary care, telehealth is a potential solution for those with limited local access to mental health specialists, they note.

Meanwhile, health centers with more patients age 65 and older appear less likely to use telehealth efficiently. This finding could reflect older patients' preference for receiving care in person, or it may be that the nature of some types of services provided to older adults is better suited to in-person provision.

In addition to Lin, co-authors included OPAE's Anne Dievler, Carolyn Robbins and Matt Quinn; and Alek Sripipatana and Suma Nair of BPHC.

Read the report abstract HRSA Exit Disclaimer (access to the full report requres a subscription).

Date Last Reviewed:  December 2018