RAND Study Finds Continuing Value in Audio-Only Telehealth Services

The study found that California FQHCs were still conducting 20% of primary care visits and 40% of behavioral care visits by telephone or audio-only computer platform.

Federally qualified health centers (FQHCs) in California are still delivering healthcare via the telephone, according to a new study from the RAND Corporation, raising the value of a modality only used since the pandemic to boost access.

The study of 30 FQHCs providing services to 1.3 million underserved residents found that, in August of 2022, audio-only telehealth was used for one out of every five primary care visits and two of every five behavioral healthcare visits.

Federal and state regulators relaxed the rules around telehealth access and coverage during the COVID-19 pandemic to enable more people to access care from their homes and help healthcare organizations reduce the spread of the virus. This included allowing providers to connect with patients by phone for some services.

Telehealth advocates say many underserved populations, especially in rural areas, can only access care by telephone, as they can't afford or don't have easy access to computers or reliable broadband. Critics say the platform isn't good enough for many healthcare services, and that a telehealth connection should at least have an audio-visual connection.

[See also: How Will the End of the PHE Affect Telehealth and Digital Health?]

While audio-only telehealth permissions will be scaled back with the end of the public health emergency in May and the two-year grace period included in the Consolidated Appropriations Act of 2023 passed by Congress, RAND researchers found that the platform still has considerable value. Some states, including California, have permanently allowed Medicare coverage for audio-only telehealth for some services, especially behavioral healthcare access.

“It is likely that these safety net clinics continued to deliver audio-only visits in high volume because of their role in improving access to health services,” Lori Uscher-Pines, lead author of the study and a senior policy researcher at the nonprofit research organization, said in a press release issued today. “Our study raises important questions about what kind of role we want audio-only visits playing in the care of disadvantaged populations and the public in general going forward.”

According to the study, which tracked the FQHCs' traffic over roughly two years, primary care visits increased by 8.5% from February 2020 to August 2022, while behavioral health visits jumped 23% during that same time. The proportion of audio-only visits, meanwhile, peaked during the height of the pandemic at 67% of primary care visits and 74% of behavioral care visits, and have since dropped back to 21% and 39%, respectively.

[See also: Audio-Only Telehealth Visits During Pandemic Draw GAO Scrutiny].

While telehealth use has declined in the wake of the pandemic as patients and providers return to in-person services, the platform still has considerable value in helping underserved populations access care and giving consumers more opportunities to connect with their care providers. Many health systems are looking to balance the two or create a hybrid approach to accessing care.

And while the argument over using a telephone or audio-only channel on a computer will continue, the RAND study indicates it's still a viable avenue for access for those who face barriers accessing care.

“It appears likely that audio only visits in these settings will remain widespread in coming years,” Uscher-Price said in the press release. “More research is needed on the effectiveness of audio-only visits to inform their use in safety net settings.”