![]() ![]() Health centers should be permitted to serve as distant sites on a permanent basis.The impact of audio-only visits on quality of care needs to be empirically tested. Data are needed to understand the impact of audio-only visits on quality of care to inform sustaining the temporary changes to reimbursement policy.Billing modifiers that differentiate between modalities are needed to further understand disparities. More work is needed to understand how telehealth helps and hinders health equity and to improve equitable telehealth access.Key facilitators of telehealth implementation were leadership support, patient willingness to use the technology, platforms that were easy to use and access, a sense of urgency within clinics, changes in reimbursement policy, and training opportunities for staff.Perceptions of whether telehealth provided an acceptable level of care were relatively positive however, there were differing views on its sustainability and its impact on equity and quality.To address disparities in access, clinics engaged in a variety of creative solutions to address the digital divide. Patients with limited English proficiency participated in a significantly lower percentage of video visits compared with the percentage of patients who typically receive primary health care services.The use of video visits varied substantially across health centers, particularly for behavioral health health centers that delivered numerous video visits and replaced audio-only visits with video visits over time had some common promising practices.At the end of the study period, however, audio-only visits were eclipsed by in-person visits for primary care, but not for behavioral health. Audio-only visits were the leading telehealth modality for primary care and behavioral health throughout the full pandemic study period.Although overall visit volumes remained about the same from the prepandemic to the pandemic study periods, the share of audio-only and video visits dramatically increased during the pandemic, particularly for behavioral health.Telehealth has the potential to increase access to care and deliver care that is more convenient and patient-centered however, ongoing research is needed to ensure that telehealth is implemented in a way that ensures high-quality care and health equity. They also present new information on the experiences of the 45 CCA health centers, drawing from data on visit trends, interviews with health center leaders, and surveys of health center providers and staff. ![]() In this report, researchers review recent literature on telehealth implementation in safety net settings. RAND researchers evaluated the progress of FQHCs that participated in the CCA initiative by investigating changes in telehealth utilization and health center staff experiences with implementation. To support health centers in these efforts, the California Health Care Foundation established the Connected Care Accelerator (CCA) program, a quality improvement initiative that was launched in July 2020. Health centers had to quickly make changes to technology, workflows, and staffing to accommodate telehealth visits. This sudden and dramatic change in health care delivery posed numerous challenges. Many Federally Qualified Health Centers (FQHCs) serving low-income patients started delivering telehealth visits in high volume in March 2020 to help maintain access to care. Telehealth proved to be a viable alternative to in-person care, at least on a temporary basis, and utilization skyrocketed. In early 2020, as the coronavirus disease 2019 (COVID-19) pandemic emerged, widespread social-distancing efforts suspended much of the delivery of nonurgent health care. ![]()
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