Health Affairs

The COVID-19 pandemic accelerated the shift to virtual health care, with patients expected to interact through portals, secure messaging, and video visits, and with providers monitoring conditions using connected devices that collect and transmit patients’ biometric data. These technologies offer health care access for underserved communities but require internet access, devices, and digital skills.

Digital inclusion is considered a super social determinant of health and rests on four pillars: available and affordable broadband service, quality devices, digital skills and training, and technical support for using accessible applications. Evidence suggests two pathways through which digital inclusion and health equity are connected. The direct pathway is through increasing access to health care services.

Telemedicine use remains substantially higher than it was before the COVID-19 pandemic, although it has fallen from pandemic highs. To inform the ongoing debate about whether to continue payment for telemedicine visits, this report estimated the association of greater telemedicine use across health systems with utilization, spending, and quality. In 2020, Medicare patients receiving care at health systems in the highest quartile of telemedicine use had 2.5 telemedicine visits per person, compared with 0.7 telemedicine visits per person in the lowest quartile of telemedicine use.

There’s no doubt that more patients and providers are relying on telehealth than ever before. But rural Americans are 10 times more likely to lack broadband access than their urban counterparts. This rural telehealth crisis must be addressed at the federal level. Whatever the total cost of solving the rural broadband challenge, it is clear that tens of billions of dollars in federal investment is needed. Critics may claim that the private sector can, and should, solve this problem. But if that were true, it would have already done so.