Telehealth Needs Assessment Content: Ashley Cram and Amgad Farah
Design: Lindsay Jorgenson June 2024 Click the left/right arrows or use your keyboard arrows to move through the findings.

Background

What Is the Telehealth Survey?


The Association of State and Territorial Health Officials (ASTHO) supports states and territories in leading policies and programs that expand access to health services through telehealth.
Between February and March 2023, the ASTHO Telehealth Peer Network program distributed an annual needs assessment survey to members to identify areas of interest and technical assistance needs related to telehealth. The survey also assessed how health agencies use telehealth for clinical care delivery. The information in this report will inform ASTHO programming and provide peer network members with expertise and resources for advancing telehealth in their jurisdictions.

Why Is Telehealth Important?

two houses with an image of a phone ringing.




Telehealth increases access to care, addresses workforce shortages, and ensures continuity of public health programming.





“Being a rural state, telehealth can help fill some gaps in health care related to access.” - survey respondent

two houses with an image of a phone ringing.



“Telehealth is important in expanding access to care and promoting health equity.” - survey respondent

Who Responded to the Survey?

icons showing a total of 14 participants, with four being Island Area health agencies and 10 being State health agencies.








Fourteen ASTHO member jurisdictions participated in the survey,
including four U.S. territories. Ten of the 14 respondents (71.4%) are members of ASTHO’s Telehealth Peer Network, and three respondents expressed interest in receiving information about joining the Network.

How Is Telehealth Structured?




Telehealth operations vary in capacity and structure.

Two respondents reported having an Office of Telehealth within their agency. One indicated that their Office of Telehealth includes two full-time equivalent (FTE) employees, where an office director reports to a division chief in field operations. The other respondent indicated that their Office of Telehealth has two part-time employees who report to senior leadership.

Figure showing fourteen building icons. Two are orange. Of the two, one has two people representing 1 full-time equivalent (FTE) and the other has two people representing 2 FTE.

Where Does Telehealth Fit?




Telehealth spans multiple programs without central coordination.

When asked to describe the organizational structure of telehealth operations, 71.4% of respondents (n=10) reported that telehealth activities occur across various agency programs and departments without a central coordinating entity. The operational structures detailed in Table 1 are highlighted by the following quotes:



“The program is part of the development and planification of the [jurisdiction] Department of Health.”


“We are currently studying the establishment of telehealth services in the [jurisdiction], where not all [areas] have stable internet connections, and not everyone can access mobile phones.”

Structure of Telehealth Operations Number of respondents

% (n)
Telehealth activities occur across various agency programs and departments without a central coordinating entity. 71.4% (10)
There is an office dedicated within the agency for telehealth. 14.3% (2)
There is an FTE position that coordinates telehealth activities across the agency. 14.3% (2)

Telehealth for
Healthcare Delivery

How Are Agencies Using Telehealth?


Telehealth at public health agencies includes more than patient care.

State and territorial health agencies use telehealth to educate healthcare personnel, advise on telehealth policy decisions, and provide direct clinical services to patients. Telehealth education activities include virtual learning sessions, distant learning, and Project ECHO.

What Services Are Provided via Telehealth?*

*In some cases, aspects of the service may be delivered via telehealth in combination with in-person delivery.

Agencies that responded to the telehealth survey deliver the following clinical services via telehealth within their jurisdiction…

icon of a brain Behavioral Health
Assessment and counseling for mental health and substance use disorders.


icon of a family Family and Child Health
Prescribing for family planning, prenatal care visits, early intervention services for children with special healthcare needs, well-child visits, and school health clinical services.

icon of a virus Communicable Disease Programs
TB screening and treatment and other STI counseling.


icon of a heart Chronic Disease
Cardiovascular disease, prediabetes, diabetes, and hypertension screenings, risk assessments, and treatments.

Who Provides Clinical Services via Telehealth?

Figure showing the following: Four agencies employ or contract internal medicine providers, primary care physicians, and registered nurses. Two agencies employ or contract community health workers, nurse practitioners, and physician assistants.

Who Receives Clinical Services via Telehealth?

figure showing the following: Four agencies serve adults and children enrolled in medicaid or uninsured. Three agencies serve adults and children who are medicare-enrolled, dual-eligible, or commercially insured. One agency serves active duty military enrolled in Tricare.

What Telehealth Modalities Are Used?




Live video streaming is the most frequent form of telehealth used by responding public health agencies.

Others included patient monitoring and asynchronous store-and-forward. Descriptions of these types of modalities can be found by hovering over bars within the chart. For those using a screen reader, descriptions are more quickly found here.

How Do Agencies Track Telehealth Data?




Health agencies use varied sources to track telehealth utilization.
Challenges for telehealth data collection include data sharing restrictions, lack of all-payer databases, lack of awareness of telehealth data collected across public health programs, and inability to differentiate between telehealth and in-person services data.

Icons showing that six respondents reported that their health agency uses electronic health records to track telehealth service utilization, 5 agencies reported using state Medicaid claims, and three agencies reported using data collected for other federal programs.

Health Agency
Telehealth Goals

What Are Agencies’ Telehealth Goals?

icon of a family Agencies seek to expand access to clinical services, especially for populations who are underserved by the health system


icon of a book with a medical symbol Agencies aim to deliver patient care and provide telehealth education

icon of a chart Agencies aim to use telehealth technology to evaluate their programs


icon of a data cloud Agenices hope to build telehealth infrastructure for robust and widespread uptake

What Are Agencies’ Telehealth Goals?



How have agencies prioritized telehealth services to rural communities and those enrolled in Medicaid, Medicare, dual-enrolled, or uninsured?

  • They have expanded telemonitoring services through partnerships with federally qualified health centers and rural health clinics.


  • They are providing specialized equipment, funds for technology modernization, and technical assistance.


  • They have developed telehealth strategy tailored to the geographical circumstances of a jurisdiction.


  • They are partnering with state Medicaid offices regarding telehealth services.

Who Are Agencies’ Telehealth Partners?


Public health agencies rely on partnerships to advance their telehealth goals.

Public health agencies partner with state Medicaid agencies to coordinate services, develop policy (e.g., reimbursement and coverage of services), and collect data. Partnerships with other entities focus on policy development (e.g., telehealth coverage and reimbursement efforts), service coordination, data collection and evaluation, financing (e.g., developing value-based payment models), and other work such as supporting broadband coverage and developing programming.

What Are Barriers to Telehealth?




Agencies are experiencing barriers to implementing telehealth, but these can be solved.

The most-reported barriers include lack of visibility across agency programming, lack of comprehensive billing data, and lack of marketing and education of telehealth options.

What Do Agencies Need for Telehealth?


Funding is the biggest need for public health agencies to advance telehealth goals.

The three top needs that follow funding involve strategies and understanding telehealth or telehealth-adjacent policy. These barries can be addressed by increasing support or technical assistance to agencies.

Let’s Support These Needs,
Together

For Agencies:


A circle with an icon of three people inside. Join ASTHO’s Telehealth Peer Network. For more information, please contact an ASTHO staff member at ask@astho.org.

A circle with an icon of a paper and a checkmark. Conduct a landscape assessment of telehealth policies and programs happening across your health agency and jurisdiction. See great examples from NC Division of Public Health and Washington State Department of Health

A circle with an icon of a blowhorn inside. Develop and advocate for statutory and/or regulatory policies that enable broad telehealth use (e.g., audio-only services, etc.).