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The Barriers and Benefits of Expanding Telehealth Access for Veterans

Veterans turned to telehealth care in droves during the COVID-19 pandemic. Data from the Department of Veterans Affairs showed that, early in the pandemic, veterans used telehealth more than 120,000 times per week via the VA’s Video Connect mobile health app. The platform, which launched in 2017, typically saw about 10,000 visits per week before the pandemic and has now become one of the most successful digital health platforms in the country.

But telehealth has been a priority for the VA since well before the pandemic. In fact, the department has been experimenting with the technology since the 1990s. This post will outline why telehealth has become a vital tool to help the VA provide essential care to the 19 million veterans living across the country, as well as what the future may hold for such technology.

What are the challenges of health care access for veterans?

Veterans have consistently named distance from health care centers and specialists as a significant barrier to acquiring necessary care. This challenge is particularly acute for rural veterans, who constitute a quarter of all veterans in the United States. Veterans, like all rural residents, have suffered disproportionate hospital closures, health care provider shortages, and limited transportation options compared with people living in or near urban centers. Additionally, veterans over age 65 represent more than half of veterans living in rural areas. They often have multiple chronic conditions and other health issues that require specialized care. Other obstacles all veterans face in accessing health care – particularly mental health care – include availability of specialized services, bureaucratic obstacles, limited hours of operation of health care centers, and perceived stigma.

What are the main benefits of telehealth for veterans?

Telehealth has been shown to alleviate some of the barriers veterans face in pursuing quality health care. A 2016 study published in the Journal of Telemedicine Primary Care Providers showed that the VA’s telemedicine program “improves access, productivity, and the quality and coordination of care.” The study also indicated that virtual care helped veterans with multiple chronic diseases attend more frequent visits with physicians, leading to better disease management.

In a 2020 study published by Public Policy and Aging, researchers found that VA telehealth programs increased quality of life for both veterans and their caregivers, improved access to resources such as durable medical equipment, and led to more timely diagnoses and care planning. Of course, throughout the pandemic, finding appropriate points of care to reduce personal COVID-19 risk for vulnerable patients, and to safeguard the community, has been critical.

What are some examples of successful telehealth programs for veterans?

The VA has successfully piloted several telehealth programs that address general preventive health care, mental health care, and specialty health care:

  • In 2019, the VA launched the Advancing Telehealth Through Local Access Stations (ATLAS) program to serve veterans in rural areas. Through ATLAS, veterans in areas that were not served by a clinic could book appointments at “remote telehealth exam rooms,” designated areas in “convenient community-centric locations, including libraries, veteran service organizations, even Walmart.”
  • A year later, just before the pandemic, the VA established its first telemedicine-based chemotherapy clinic, linking two VA hospitals 100 miles apart in Pennsylvania. Veterans living in the Altoona area were able to receive virtual care from experts in Pittsburgh. Impressed by the program’s progress, in June 2020, the Bristol Myers Squibb Foundation made a $4.5 million grant to the VA to further develop its virtual chemotherapy platform.
  • A study published in a 2021 issue of BMC Health Services Research highlighted a national program called TeleSleep designed to diagnose and treat obstructive sleep apnea, a common condition among rural veterans. The telemedicine program, launched during the COVID-19 pandemic, included virtual clinical encounters, home sleep apnea testing, and an app that veterans and providers could use to monitor symptoms. The program’s benefits – reduced travel burdens and higher health and quality of life outcomes – “assured leaders and clinicians that the comprehensive shift in all VA sleep care to telehealth during the COVID-19 pandemic would facilitate improved access to care.”

What barriers do veterans face in using telehealth solutions?

The barriers veterans encounter when engaging in telemedicine are similar to those of the general population – especially those in underserved areas – including a lack of broadband internet access and uncertainty over reimbursement, credentialing, and other health care policies.

In the TeleSleep study, rural veterans reported difficulties in appointment scheduling, the continuity and timeliness of communication, and the process to refill their equipment. Patients and practitioners involved in another VA telehealth program highlighted in the 2020 Public Policy and Aging article described an intense start-up process (including training teams, establishing processes, and securing necessary equipment) and a high degree of staff turnover as areas of concern.

But the biggest challenge veterans and their caregivers face regarding telehealth centers on policy. To facilitate and expand telehealth services for veterans, policymakers will need to clarify, amend, and extend rules related to telemedicine reimbursement and ensure patients and physicians have access to the tools – like broadband internet and mobile devices – they need to participate in telemedicine.

What does the future of telehealth for veterans hold?

The Biden administration appears to have an interest in keeping or expanding the relaxation of regulations on telemedicine after the pandemic, for the public, and for veterans. In June 2021, VA Secretary Denis McDonough stated his intention to keep telehealth and online medical appointments as part of the VA’s health care offerings. Noting that online video appointments for veterans were 18 times higher than they were at the start of the pandemic, McDonough said, “I think, as a system, we recognize the huge efficiency gains and huge satisfaction gains from veterans spending less time traveling to our facilities while still getting good care.”

The ability to enshrine such changes as permanent, however, lies with Congress. The good news is that Congress appears receptive. In June, the House Appropriations Committee approved $279.9 billion for military construction, Veterans Affairs, and related agencies. It includes “more funding than requested” for the VA, to the tune of $100 million. That funding is intended for several causes but specifies funding for “telehealth and connected services,” including “home telehealth, telehealth prosthetics, and clinic-based telehealth.”

In short, telehealth has become an invaluable tool in providing health care to veterans no matter where they live in the country. Other large health care providers would do well to learn and where appropriate emulate the example the VA has set for effective virtual care.

Learn more about expanding telehealth access to underserved rural populations.

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