During the COVID-19 pandemic, many health plans and providers have turned to telemedicine as a way to safely deliver services to patients. Before the novel coronavirus arrived on the scene, Medicare only covered telehealth services for certain providers and patients were usually limited to those in rural areas or at a medical facility.

With the pandemic, both CMS and private insurers have temporarily changed their telemedicine rules. Since early March, at least 10 million Medicare beneficiaries have taken advantage of telehealth services. Between April 2019 and April 2020, FAIR Health reports that telehealth claims increased 8,336%.

Seniors Face Physical, Technical and Socioeconomic Challenges Related To Telehealth

In general, telehealth has worked well for many individuals. Some worry, however, that older adults may have difficulties with telemedicine and/or prefer to be seen in the office, or not at all. This is a legitimate concern since older adults represent one-quarter of physician office visits in the United States. This population also often manages multiple conditions, medications and has higher rates of disability.

Research published recently in JAMA Internal Medicine identified a variety of challenges related to telemedicine that older adults may face. These obstacles include familiarity using mobile devices, troubleshooting technical issues that arise, managing hearing or vision impairments, and dealing with cognitive issues like dementia.

Socioeconomic issues are also a worry. Not all seniors can afford to buy mobile devices or Internet plans. Some providers have also found that patients with cell phones stop answering calls at the end of the month because they run out of minutes on their plans.

Fortunately, Telemedicine Hurdles Can Be Overcome

Recognizing that telehealth isn’t a “one-size fits all” solution is the first step towards addressing this situation. Work is needed on multiple levels to help older adults benefit from telemedicine. In response, organizations must:

• Improve access to Internet service and to devices. Telemedicine consults are impossible without access to the Internet. Expanded broadband access is needed in rural areas. In addition, older adults in community-based living environments need access to public wi-fi networks. Access to mobile devices is also essential. Products designed with large fonts and icons, closed captioning, and easy set-up procedures may be easier for older adults to use. One example is the “GrandPad.” To address affordability, CMS allowed for mid-year benefit changes in 2020 to allow for payment or provision of mobile devices for telehealth.
• Provide educational resources. Even if older adults are open to using technology for telehealth visits, many will need additional training. Healthcare organizations may want to connect older patients with community-based technology training programs. Some programs take a multi-generational approach, pairing younger instructors with older students.
• Address systemic biases. Some worry that telehealth encounters could reinforce biases. Providers may be less conscious of systemic bias toward patients based on race, ethnicity, or educational status. The algorithms that support telemedicine systems may also have racism and class bias embedded in them. Work will be needed to address these concerns.
• Segment the population. To match members and patients with the right resources and assistance, health plans and providers should launch outreach campaigns that are segmented by demographic group. Outreach initiatives could include assessments to determine each person’s ability and comfort level with telemedicine. It’s also important to take cultural competency into account when offering telemedicine services. Individuals who aren’t fluent in English, for example, may find it easier to communicate with providers in a face-to-face setting than through telemedicine.

Telemedicine is certainly playing a central role in delivering care during this pandemic and in many instances, it is having positive results. Research has found, for example, that diabetes management appointments conducted via telehealth had better than or comparable results to in-person interactions. Telehealth has the potential to address several barriers to care for vulnerable populations, such as older adults, for whom access to in-person care may not be viable. With Medicare reimbursing telehealth services at the same rate as in-person office visits, make sure your high-risk members with chronic health conditions know about their options to receive telehealth services by incorporating this information into your targeted outreach programs.  

HMS’s engagement solutions are designed to simplify member and patient engagement while providing predictive analytics that highlight segments of the population that may need additional support in different areas. To learn more about how HMS’s engagement solutions can help your organization bridge the gap between older adults and telemedicine, feel free to contact us.

About the Author

Anne Davis is the Director of Quality Programs & Medicare Strategy at HMS where she focuses on the company's Population Health Management product portfolio. Anne has spent the last 20 years focusing on healthcare quality, care and evaluation. Prior to joining HMS, Anne was responsible for care management, utilization review, and population management at a five-star Medicare Advantage plan and integrated delivery system. Since 2015, Anne has worked as a consultant, focused on HEDIS and Stars, quality programming, and reporting & evaluation. When she isn’t working, you’ll find Anne at the beach with her family, teaching yoga classes and hiking in her beautiful home state of Maine.

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