RAND Report Finds Audio-Only Telehealth Use Common Among Safety-Net Facilities

A RAND Corporation analysis discovered that audio-only telehealth visit numbers at safety-net health clinics remained greater than video-based treatment during the COVID-19 crisis, particularly for behavioral health services. The researchers analyzed 45 Federally Qualified Health Centers in California that offer healthcare services to lower-income populations to conduct the study. 

The researchers assessed the centers’ telehealth experiences by examining data on in-person and telehealth visits, speaking with health center leaders, and surveying health center employees and doctors. All of the study respondents received funding from ‘The California Health Care Foundation’s Connected Care Accelerator’ program, which was introduced in July 2020. The project’s objective was to support health facilities during the COVID-19 pandemic as they made the switch to telehealth and preserve access to primary care and mental health services through the provision of virtual visits. 

“As compared to other settings, there are more barriers to providing telehealth on both the provider side and the patient side in safety net settings,” explained Lori Uscher-Pines, lead author of the study and a senior policy researcher at RAND Corporation. “These providers and their patients are likely to have fewer resources to support dramatic changes to healthcare delivery such as telehealth.”

Overall, visit numbers were found to have remained relatively constant throughout the pre-pandemic and pandemic study periods, although the proportion of audio-only and video visits increased significantly during the pandemic, especially for behavioral health. Audio-only visits were the most popular telehealth service for primary care and behavioral health. However, in-person visits surpassed audio-only visits for general care by August 2021, but not for behavioral health. In addition, the report indicated that health used video visits in various ways, especially when it came to behavioral health. According to the research, health centers that often used video visits and gradually replaced audio-only visits with video visits shared several promising practices that could be useful to other clinics. These include the implementation of telehealth navigator programs, evaluation of patients’ digital literacy, one-on-one patient training, establishing objectives for the quantity of video visits, and providing real-time technical assistance.

Following the publication of the report, the researchers noted that further research is required to determine how audio-only visits affect patient care quality and how they fit into a hybrid care system where patients receive a mix of telehealth and in-person visits.