CommonWealth Magazine

AT THE OUTSET of the pandemic, payers, policymakers, and providers at the local, state, and national levels rallied to rapidly expand the financial and technological infrastructure around telemedicine services. Such coordinated responses were critical to ensuring sustained, high-value, high-quality care for patients across our nation. Massachusetts specifically engaged several future-oriented telehealth services to better serve the needs of the Commonwealth.

During the COVID era, key changes supporting greater telehealth use arose from several critical developments. Improved technological access to wearable devices facilitated rapid medical responses for vulnerable populations. Policy changes loosened  up regulations around prescribing controlled substances, waived co-payments and co-insurance for many types of telehealth care, reimbursed for audio-only and video visits, and relaxed prior authorization policies.

In addition, operational changes in clinical practices allowed for providers to better integrate telehealth into their practices and forge collaborations with community-based programs to increase telehealth uptake.

In 2021 Massachusetts passed a framework extending coverage for telehealth services. However, parity in reimbursements or the degree to which providers are paid to conduct telehealth visits for various appointment types is scheduled to change over time. Notably, behavioral health service payment parity is scheduled to continue permanently – representing an opportunity to understand the impact of such reimbursement structures on cost, quality, and access to mental health.

Many of these flexible changes were tied to the formal existence of a declared COVID-19 public health emergency. As  we approach the anticipated end of the emergency, we also arrive at a moment of decision-making around policy issues affecting the future of telehealth. The greater the period in which we do not necessarily study or change policies and practices around telehealth, the greater the risk that inertia will chart a course for us. The path forward is littered with pitfalls, but also with incredible promise. We propose some steps to minimize pitfalls.

First, it is necessary for Massachusetts to consider the technological infrastructure underlying telehealth care to bridge the “digital divide.” In April 2021, roughly 30 percent of Massachusetts households with incomes below $35,000 did not have broadband access while 3 percent of households with incomes greater than $75,000 similarly lacked such services. Investing to close this gap is critical – particularly because these represent populations most likely to experience intersectional disparities in health outcomes.

Driving down the cost of broadband may also be achieved via public sector investment through increased enrollment in public benefit programs, including the Biden administration’s broadband access program. Enhancing competition and expanding high-speed networks could also play a role.  At the patient level, Massachusetts can lead the way in publicly funded efforts towards patient and provider education regarding telehealth and ensuring e-health…