Nearly a century ago, a Norman Rockwell painting titled “Doctor and Doll” was published on the cover of the Saturday Evening Post, a popular American cultural magazine.
It depicted an older gentleman wearing a suit, a doctor bag at his feet, pressing a stethoscope to the chest of a little girl’s toy doll. A cluttered desk and worn chair sit atop a forgettable rug. It’s an old image of health care in America. A country doctor caring for his neighbors via a “house call.”
Of course, we know it was not that simple. Healthcare was rudimentary compared to today’s standards – that is if you had access to care at all. Average life expectancy reflected that. If you were born White in 1929 you would be lucky to reach your 60s. If you were Black, you weren’t likely to reach your 50s.
While things are far from perfect, at least they have improved. Healthy lifestyles and modern medicine have made living into your 80s commonplace. Significant racial disparities remain, but the gap is closing. And the number of people with health coverage has never been higher. But while Medi-Cal (the state-sponsored coverage for people who have low incomes) now covers nearly 14 million people, many still lack appropriate access to care.
Access to care is a complex issue, but sometimes it’s as simple as geography. Taking an hours-long bus ride across town to visit the doctor isn’t practical for most people. Add lost wages, a lack of childcare, and the fact that you don’t feel good, and it’s downright impossible.
Solutions available in employer-based health insurance for years, like virtual care through an app or over the telephone, haven’t been an option for people on Medi-Cal. Until the pandemic. When the federal and state governments declared an emergency last Spring, Federally Qualified Health Centers like WellSpace Health were able to provide care virtually via telephone and video, a practice that had been prohibited previously.
Virtual care is wildly successful. Over the past two weeks, 5,015 patients accessed care remotely rather than visiting our health centers. Half of the primary care visits and 85 % of behavioral health visits were virtual. According to a statewide survey of community health centers, which serve 1 in 5 Californians, there has been a 75 % decrease in no-show rates since the implementation of telehealth. A study conducted by the California Pan-Ethnic Health Network reported a significant number of patients from communities of color engaging in telehealth and having a high level of patient satisfaction.
As the Chief Medical Officer for one of our region’s largest healthcare providers, and an internal medicine doctor, it makes sense. Technology has given us the ability to conduct a modern-day “house call.” We can go to the patient and break down significant barriers to care. If the patient requires a hands-on assessment or treatment, we can take that step. But frequently, especially in behavioral health, hands-on care is not necessary.
Our ability to provide virtual care under the emergency order will expire soon. The permanent authorization will require action by the legislature and the governor through the budget process. Assembly Bill (AB) 32 by Assemblymember Cecilia Aguiar-Curry (D- Winters) provides the template for action.
In this budget cycle, the Governor must take advantage of a once-in-a-lifetime opportunity to address inequality in our health care delivery system. By adopting the provisions of AB 32 into the FY21-22 final budget, it will guarantee all Medi-Cal beneficiaries – regardless of where they seek care – can use all telehealth modalities, including telephonic care, indefinitely.
Telehealth may not make for a good Norman Rockwell painting, but it does make for good medicine. It’s an improvement, a step forward that helps us get healthier and close gaps in care. It even brings back the house call.
Dr. Janine Bera is the Chief Medical Officer for WellSpace Health and Chair of the California Primary Care Association Telehealth Clinical Task Force.