Study Shows Potential for More Accessible Health Care With Telehealth

A new study produced by the Minnesota Department of Health (MDH) highlights the potential for telehealth to make care more accessible while providing similar levels of service to traditional, in-person ways of delivering care. Telehealth is the use of electronic or telecommunications technology to access health care remotely.

The preliminary report aligns with the Health and Human Services bill recently passed by the Minnesota legislature and signed into law by Gov. Tim Walz. The law extends coverage for audio-only care past its planned sunset in June 2023 while the state develops permanent policies for those services.

“Telehealth has shown strong potential for improving health care access, especially in the delivery of mental and behavioral health services,” said Minnesota Commissioner of Health Dr. Brooke Cunningham. “However, it’s important that it not be viewed as a one-size-fits-all solution. An increased reliance on video telehealth without adequate investments to address the existing digital divide and remedies for other structural inequities impacting health care delivery and outcomes could unintentionally increase health disparities.”

The preliminary report’s findings, which focus on Minnesotans with private health insurance coverage, show that the use of telehealth increased significantly during the COVID-19 pandemic. Data also showed that most patients receiving telehealth services were satisfied with their experience. Overall, about 80% of Minnesotans surveyed by MDH during the study period were satisfied with the telehealth services they received, regardless of whether it was a video or audio visit. In addition, the study found telehealth has the potential to increase access to health care by removing barriers like transportation and the need to arrange child care.

The study also highlights how phone, or audio-only, telehealth addresses narrow but important access issues, especially for Minnesotans in rural areas or with challenges accessing or using the technology supporting video-based telehealth. Without the recent legislative extension, some audio-only visits may have no longer been covered.

“Audio-only telehealth came into play during the early months of the COVID-19 pandemic and was used by many Minnesotans to access care, including mental health care,” said State Health Economist Stefan Gildemeister. “MDH is pleased that it will continue to be available to Minnesotans as we learn more about when and how it fills health care access and delivery gaps, and where ongoing availability and use is beneficial.”

In 2021, the Minnesota Legislature requested that MDH produce a study exploring the role of telehealth in the future of health care for Minnesotans. MDH’s final report will be released in 2024.

Telehealth’s impact has been particularly strong in expanding access to mental and behavioral health providers. During the first half of 2021, about 60% of all mental and behavioral health services were delivered through telehealth. This finding is especially important for improving access to care for residents of Greater Minnesota, where telehealth has the potential to fill provider coverage gaps that make attaining care especially challenging.

The report does note several equity issues to consider with telehealth. For instance, some providers reported challenges in ensuring adequate support for patients whose first language is not English. In addition, while patient satisfaction with telehealth was positive overall, it was somewhat lower for Black, Indigenous and people of color (BIPOC) Minnesotans. Communities that face disproportionate inequities in digital access and affordability, or comfort in using digital technology, face barriers to telehealth access. Still, telehealth provides opportunities to address disparities compared to in-person care, particularly the potential for connecting culturally or linguistically “matched” provider and client pairs without the barrier of physical distance.

Telehealth’s impact on quality, health outcomes and health care spending, as well as determining how to strike the right balance between telehealth and in-person care, also requires additional study, according to the preliminary report. MDH is committed to understanding whether expanding telehealth in Minnesota could occur at the expense of maintaining or improving access to and availability of in-person care.

MDH worked with Wilder Research to conduct aspects of the study. Wilder interviewed Minnesota telehealth service recipients (patients), health care providers and health care payer organizations. The report also includes data from MDH surveys of Minnesota residents, providers and ambulatory clinics, and the Minnesota All Payer Claims Database, as well as results from national studies to assess impacts in the commercial/private insurance space. Per the legislation directing the study, MDH’s report addresses the impact of telehealth on a range of factors, including access, quality, outcomes, equity and spending.

As the study continues in 2023, MDH will continue to collaborate with the Minnesota Department of Human Services as that agency studies the impact of telehealth policies on Minnesota Health Care Programs in addition to seeking input from a Technical Advisory Group of professionals from research, patient-advocate, provider and payer perspectives. MDH plans to conduct extensive analysis while collecting and compiling additional information about telehealth to help inform and contribute to solutions taking place at the intersection of health care and technology.

For more information on MDH’s telehealth research and the preliminary telehealth report are available on the Minnesota Study of Telehealth Expansion and Payment Parity webpage.