In summary

California, with its multilingual populations and rural communities that lack medical care, is the perfect place to implement telehealth.

By Arturo Vargas Bustamante and Carmela Castellano-Garcia, Special to CalMatters

Arturo Vargas Bustamante is an associate professor in the Department of Health Policy and Management at the UCLA Fielding School of Public Health, and a faculty researcher with the UCLA Latino Policy and Politics Initiative, latino@luskin.ucla.edu. Carmela Castellano-Garcia is the president and CEO of the California Primary Care Association, overseeing a membership association of more than 1,370 nonprofit, community clinics and health centers which serve nearly 7.2 million patients a year, ccastellano@cpca.org. They wrote this commentary for CalMatters.

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The increased use of virtual care, or telehealth, has proven successful amid the COVID-19 pandemic, and its ongoing use offers long-term solutions as uncertainty remains over potentially multiple waves of COVID-19 and the timeline for a vaccine. 

It’s time to consider telehealth as a solution to improve medical and behavioral health access for low-income communities that have been hard hit by the pandemic. 

With a few infrastructure and policy changes, telehealth can continue to transform medical access and reduce health inequities, while improving quality of care and reducing costs. California, with its multilingual populations and rural communities that lack medical care, is the perfect place to implement telehealth as a solution. 

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The Trump administration announced in March that telehealth benefits would be expanded for Medicare recipients during the current pandemic, an important step in increasing its use among underserved populations. State requests for flexibility with Medicaid programs have also been approved. 

COVID-19 has put a spotlight on the health inequities that working poor and communities of color face. Latinos and black residents are falling ill and dying at disproportionate rates, both because of their increased exposure and inability to access proper testing and care. 

According to the UCLA Latino Policy and Politics Initiative, where one of us conducts research, more than 7 million Latinos in California could receive improved access to health care through an expansion of telehealth. 

In rural areas, the lack of primary care physicians is dire: only 11% of the state’s doctors practice in these communities, and there are few specialized practitioners. Furthermore, Latino patients and other monolingual populations rarely have the opportunity to discuss their health care needs with someone who speaks their language or understands their cultural needs. 

According to the Pew Research Center, 96% of Latinos have access to a mobile device, with 79% being smartphone users. However, less than 60% of low-income households have access to broadband internet or a computer device.

The high adoption rate of mobile devices provides a technological entry point for medical providers to reach Latinos in underserved areas, but improvements to broadband access are an important investment for the widespread adoption of telehealth medicine. The potential of telehealth raises the need for better broadband infrastructure in rural communities, which can also help as people do remote work and home schooling. 

Multilingual doctors can also use telehealth to reach a greater number of patients and bridge the language gap for patients across the state. Other care team members can also be used to increase language support, which can be particularly helpful in reaching indigenous communities in rural areas that speak neither English nor Spanish. 

Community health centers are a great place to start. They serve more than 7.2 million Californians, where one in three Medi-Cal recipients live. Many are using telehealth as a way to provide non-urgent primary care and behavioral health care to their patients during the COVID-19 crisis, and technological and policy improvements could help them reach more people. 

Community health centers have roots in the community and trusted relationships to best utilize telehealth services. But, current policies are getting in the way.  The current declaration of emergency will be lifted well before the threat of COVID-19 is gone.  We must make sure community health centers can bill, and be paid for, virtual care well into the future. 

It’s been said that the pandemic has offered an opportunity to improve structural issues, and telehealth can be part of the solution. Reliable medical and behavioral care is now more important than ever, and telehealth is the kind of innovation that California is known for. Now is the time to show why California continues to be a leader in health and make telehealth services an ongoing method of providing care for the health of our state.  

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Arturo Vargas Bustamante is an associate professor in the Department of Health Policy and Management at the UCLA Fielding School of Public Health, and a faculty researcher with the UCLA Latino Policy and Politics Initiative, latino@luskin.ucla.edu. Carmela Castellano-Garcia is the president and CEO of the California Primary Care Association, overseeing a membership association of more than 1,370 nonprofit, community clinics and health centers which serve nearly 7.2 million patients a year, ccastellano@cpca.org. They wrote this commentary for CalMatters.

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