January 27, 2025
Telehealth has been recognized as a critical tool for improving health care access in rural areas, where people often face barriers to care. New findings from an OCHIN-led research project highlight telehealth’s role in expanding access in these areas. They also underscore the ongoing need for funding to optimize telehealth, particularly audio-only services, to bridge the gap for rural and low-resource communities.
Improving rural health care access with telehealth
Despite its promise, the early pandemic surge in telehealth use disproportionately benefited urban residents and health care providers, largely bypassing rural communities. While changes in reimbursement policies have improved adoption, people in rural areas with low incomes still face barriers such as inadequate broadband access, limited device availability, and low digital literacy.
The introduction of reimbursement for audio-only telehealth has emerged as a significant equalizer, offering new opportunities for these low-resource communities to access care. The flexibility to provide audio-only services has enabled health care providers to maintain access to care for many people who lack access to broadband or video conferencing technology, especially those in rural areas.
OCHIN has received funding from the Agency for Healthcare Research and Quality to study the impact of the widespread expansion of telehealth on preventive health care services and the quality of care for people with low incomes in rural areas compared to those in urban areas. Led by Annie E. Larson, PhD, MPH, a rural health research investigator at OCHIN, this research aims to inform efforts to improve health care access and quality for rural residents with low incomes, ensuring rural-urban differences in health outcomes do not continue to widen.
Key telehealth findings highlight critical rural needs
OCHIN’s most recent paper from this project—in partnership with researchers from Oregon Health and Science University, Case Western Reserve, Oregon State University, and University of Iowa—found that from April 1, 2021 to March 31, 2023 (the end of the COVID-19 public health emergency), telehealth visits in primary care community-based health clinics decreased for patients living in urban areas. In contrast, telehealth visits remained the same for patients in rural areas.
Other key findings include:
- By the end of the public health emergency, rural patients were using telehealth 5.1 percentage points more than urban patients (29.5% of visits in small rural areas vs. 25.7% of visits in urban areas).
- When telehealth visits occurred, twice as many visits by patients in urban areas and three times as many visits by patients in small rural areas were conducted via audio-only (rather than video and audio telehealth).
- No change in modality of telehealth delivery from the start to the end of the study period.
“These research findings underscore the importance of telehealth as Congress considers the extension of the Medicare telehealth flexibilities,” said Sylvia Trujilo, OCHIN’s vice president of public policy and regulatory affairs.
“The research provides evidence that rural communities need the full array of Medicare flexibilities to enable their use of these tools and resources, including audio-only services, now more than ever.”
Ensuring sustainable telehealth delivery
In addition to underscoring the continued importance of telehealth—including audio-only services—in community-based health centers across the OCHIN network, the findings emphasize the need for ongoing funding to optimize telehealth in rural communities. This includes ensuring the necessary infrastructure, workflows, and workforce are in place to support sustainable delivery and reinforcing the critical role of these telehealth modalities in providing essential access, especially in rural areas.
For evidence-based resources to support adoption in rural communities, visit the Health Resources and Services Administration (HRSA)-funded telehealth resource centers, such as the California Telehealth Resource Center.
