• AHAP Inc.

FQHCs Find Audio-Only Telehealth Valuable During Pandemic

Center for Connected Health Policy recommends that policymakers continue to make audio-only available as an option, work to decrease digital divide.


The Center for Connected Health Policy (CCHP) recently conducted a study examining the use of audio-only as a modality to provide services from Federally Qualified Health Centers (FQHCs) to Medicaid patients. CCHP offered several recommendations to policymakers regarding the use of audio-only by FQHCs to deliver services beyond the pandemic.

The CCHP, a nonprofit, nonpartisan organization working to maximize telehealth’s impact, found that although FQHCs are in a unique position to help fill the need for at-risk patients, they have faced a complex matrix of state and federal policies that govern the use of telehealth at their centers.


Although during the pandemic they have been temporarily allowed to deliver care via telehealth and telephone in Medicare and in most state Medicaid programs, questions regarding the longevity of the temporary policies remain.


The telephone has not been thought of as telehealth, with many states excluding it from their definitions, and policymakers initially were skeptical of its use. CCHP studied the impact these temporary audio-only changes have had on how FQHCs can deliver care and the potential impacts if the policies are not made permanent will be examined.


CCHP interviewed FQHC officials, primary care associations and medical boards in five states that have a specific audio-only policy for FQHCs: Arizona, Arkansas, Iowa, North Dakota and South Dakota.


A significant portion of the patients served by the interviewed FQHCs were covered by Medicaid. For the FQHCs interviewed, audio-only visits averaged out to about 15 to 30 percent of their total visits. They told CCHP that there was a higher volume in the early days of COVID-19 and the use of telehealth in general started to decrease after the first few months. The types of services provided via audio-only were behavioral health, chronic conditions, acute care such as sore throats or flu-like symptoms, and refills on prescriptions.

Some providers also noted that their comfort level using audio-only increased when they were dealing with an established patient whose history they were very familiar with, the report said.


Several FQHC leaders said that the most significant reason audio-only was used was due to connectivity issues, followed next by access to video equipment, although some patients might have live video available to them, but are intimidated by the technology and prefer the more familiar audio-only option.


CCHP asked the FQHCs what the impact would be should audio-only cease to be available as an option to provide services. They said that it would most likely mean the cessation of services to some of their patient population as they may have difficulty utilizing live video or coming into the clinic for an in-person visit.


Based on its research, CCHP recommend that policymakers continue to make audio-only available as an option for FQHCs to provide services, at least during the pandemic. It also recommends that policymakers address the connectivity issue. “As the interviewees noted, audio-only was primarily used because connectivity was a major issue for patients. While building out adequate connections may take some time, policymakers should address other measures that can bridge the gap until everyone does have broadband access," the report states. "Such solutions could include subsidies to access the internet, providing hot spots in certain regions, offering training on how to use technology for those who need help with digital literacy, and providing equipment to access live video such as laptops or smartphones."


David Raths is a Contributing Senior Editor for Healthcare Innovation Oct 20, 2021

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