Ensuring access to virtual care Ascension is breaking down telemedicine barriers
D
uring the COVID-19 pandemic, Ascension saw a significant shift in consumer behavior around virtual care and a sharp spike in use of this technology. In fact, Ascension experienced a 100-fold increase, with 720,000 virtual care visits compared to the same period (March through May) last year. Although this adoption has created another access point for patients, Ascension leaders are mindful of barriers that it may create for at-risk populations. “There is concern that virtual care’s selective use may compound long-standing health disparities,” said Baligh Yehia, MD, MPP, FACP, Senior Vice President, Ascension, and President, Ascension Medical Group. Many of the populations facing Dr. Baligh Yehia challenges in accessing in-person care — such as racial/ethnic minorities; persons living in rural communities; those with lower socioeconomic status; individuals with limited English proficiency; and those with low health literacy — may also face barriers in accessing virtual care. “If virtual care continues to accelerate without engaging these vulnerable communities, it may sustain or exacerbate existing health disparities, something that Ascension has worked very hard to address during more traditional in-person visits,” Dr. Yehia said. Ascension is mitigating these potential inequities in virtual care in three ways: 1) Identifying and resolving barriers to virtual care by understanding them for new patients during the registration process, and looking at technology solutions for new and existing patients that do not require a smartphone, but instead need only text messaging capability and cellular data, which can help facilitate access to those without Wi-Fi or smart devices.
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G O O D DAY A S C E N S I O N / A S C E N S I O N .O R G
The single biggest predictor of whether someone expects to use virtual care is whether he or she has used it in the past. A poll of individuals who used Ascension Online Care during the COVID-19 pandemic found that 75% are more likely to use it again compared to those who have never used it at all. This suggests that if we can find virtual care solutions that work for vulnerable populations — by addressing access to smartphones, broadband internet, digital literacy and cost — and get them to try it once, they are likely to use it again. In the interim, Ascension is encouraging hybrid workflows that support a mix of telephone, video, in-person and home/community-based visits to ensure we reach these populations. 2) Addressing variations in clinician behavior and use of virtual care by enhancing and optimizing our facility-based telemedicine programs to offer more services to critical access hospitals and care clinics. We know that some clinicians may not offer televideo visits to individuals they assume do not have access to a smartphone, may have challenges using technology, or may not be interested in virtual care. However, according to a University of Michigan National Poll on Healthy Aging, almost half of patients between 50 and 80 years old preferred virtual care for follow-up visits. Ascension is helping clinicians expand their understanding of patient preference and use of virtual care, as well as helping them incorporate virtual care into their practice through ongoing training and education opportunities. 3) Advocating for structural, payment and policy changes for virtual care. To ensure we are able to provide access to virtual care that will best serve our diverse patient populations, Ascension advocates for statutory and regulatory reforms. These include addressing where Medicare and Medicaid patients and clinicians must be located, both physically and geographically, in order for virtual care services to be provided and covered; appropriately reimbursing
