Growth of telehealth improves access to care

rior to the onset of the COVID-19 pandemic, many healthcare providers found it difficult to incorporate telehealth into their practice. The technology could be unreliable, it was challenging to get all the information needed during a visit, and both providers and patients alike felt uncertain about missing out on the important in-person interaction and the experience of personal connection that develops in these settings.

Left with few other options once in-person visits were curtailed due to COVID-19, our providers swiftly pivoted, adapting their workflows and approaches to the new medium.

“Before the pandemic, we were starting to offer telehealth for patients and finding that for working women and postpartum women especially, it really facilitated their engagement in therapy because they didn’t have to take time to travel,” said Catherine Monk, PhD, Director of Women’s Mental Health @Ob/Gyn in the Department of Obstetrics and Gynecology at NewYork-Presbyterian/Columbia University Irving Medical Center. “I think it was lifesaving for people to have access to mental health care at the start of the pandemic. There are a lot of people in need we would have been missing without it.”

Telehealth also offered unexpected benefits for many patients’ different healthcare delivery needs.

“To avoid multiple trips to the office for in-person appointments, in the past patients typically came in for genetic counseling on the same day as their diagnostic genetic procedure,” said Erica Spiegel, MS, Manager of Genetic Counseling in the Women’s Genetics program at NYP/CUIMC. “Other patients would have genetic counseling after their ultrasound and consults at the end of a long day. For patients who were undecided or feeling overwhelmed, this didn’t give them enough time to sit with the information. Now with telehealth, we space these appointments out, and it gives them more time to process the information, talk with their partner and support network, and come to the right decision for their family.”

Another advantage to telehealth is that it lowers barriers to care for patients outside of New York City, who might not have access to the level of specialty care provided by Columbia experts in their own area. 

“Genetic counselors and geneticists are a limited resource nationally, especially in our specialty – there’s a small group who are experts in complex genetic results and fetal findings,” Spiegel said. “We’ve been able to reach patients who don’t live locally, who seek us out for our expertise because of info they’ve found online. If they needed to come into the city to get care, we might never see them.”

Patients have long struggled with access to certain types of care, particularly mental health care, owing to the challenges of billing and reimbursement through insurance. In the New York City area particularly, many mental health care providers don’t accept insurance, as it can be prohibitive cost-wise to running a successful practice. 

“Taking insurance coverage for mental health care is an incredibly difficult financial model because it simply doesn’t cover our admin costs and overhead,” Dr. Monk said. “But telehealth has the potential to reduce costs to make the acceptance of insurance possible. With telehealth, more providers might be more willing to be on insurance panels. For our division, it’s getting us closer to breaking even.”