Use of Telehealth Early and Late in the COVID-19 Public Health Emergency: Policy Implications for Improving Health Equity

Introduction: Early in the COVID-19 pandemic, primary care adopted telehealth rapidly to preserve access. Although policy flexibilities persist, but with in-person access restored, insight regarding long-term policy reform is needed for equitable access, especially for underserved, low income, and rural populations. Methods: We used electronic health record data to compare primary care telehealth use in practices serving primarily commercially insured patients versus clinics serving low-income uninsured patients, in March-June 2020 ("early COVID") and March-June 2022 ("late COVID"). Results: Primary care visit mode differed significantly (P<.0001) between settings in both periods. In early COVID, video visits were most used in the commercially insured practices (54.50%), followed by office visits (32.76%); in the low-income, uninsured clinics, phone visits were most used (56.67%), followed by office visits (23.55%). In late COVID, 81.05% of visits to commercially insured practices and 92.04% to uninsured clinics were in-office; continuing telehealth use was primarily video. Smaller but significant (P≤.0001) differences in telehealth use by race/ethnicity were also observed, with Black and/or Hispanic patients less likely than White patients to use telehealth during both periods, after adjustment for other characteristics. Conclusions: Findings demonstrate the importance of both phone and video visits in preserving primary care access early in the pandemic. Telehealth use declined in late COVID, but still accounted for ;20% of primary care visits in the commercially insured setting and less than 10% of visits in the community care clinics. Differences in telehealth use were largely by setting, reflecting income/insurance status, indicating disparities needing to be addressed.