New Telehealth Data Identifies Barriers to Access

Providing health care services remotely through telehealth has the potential to improve access to care and advance health equity, especially for patients in rural and under-resourced communities. The Office of eHealth Innovation (OeHI) and the Center for Improving Value in Health Care (CIVHC) joined forces to better understand the nuances of telehealth use, unearthing critical insights into barriers that may hinder access. The groundbreaking analyses shed light on telehealth equity and barriers to care.

Telehealth Equity: Impact of Social Barriers on Telehealth Use

The recently released Telehealth Equity Analysis breaks new ground by investigating the relationship between social determinants, such as transportation and internet connectivity, and telehealth usage at the neighborhood level. The interactive report pairs data from the U.S. Census and the Colorado All Payer Claims Database (CO APCD) and is a first step towards understanding how social factors relate to telehealth and in-person visits.

Results indicate that communities with a higher percentage of individuals and households without computers or smartphones tend to have fewer telehealth visits, while those without vehicles use telehealth more often. The other seven social factors evaluated, except for Veteran status*, had little to no relationship on telehealth or in-person visits at a statewide level. Future iterations of this report may include additional measures such as income level to determine if there are other social factors that relate to telehealth use.

Kristin Paulson, CIVHC President and CEO, emphasized the power of combining claims data with external social determinants of health information. "Conducting these types of analyses is crucial for pinpointing areas where we can reduce health disparities. We are grateful for our partnership with OeHI and the ability to help inform ways to increase access to telehealth services."

In addition to supporting OeHI’s work, communities, organizations, and individuals can use the Telehealth Equity Analysis to focus efforts on reducing potential barriers to telehealth or in-person services by:

  • Gaining insights into the disparities between telehealth and in-person visits at the state, county, and neighborhood levels.
  • Examining social determinants that relate to the use of in-person or telehealth visits.
  • Creating programs or initiatives aimed at enhancing access to telehealth or in-person services, focusing on addressing social factors.
Provider Barriers: Telehealth Payments and Denied Claims

Despite Colorado law mandating equal payments, in a 2022 survey, Colorado providers indicated lower reimbursement rates and denied claims as major barriers to providing telehealth services.To investigate payment variation, CIVHC analyzed commercial payer data in the CO APCD and confirmed that overall, providers were paid less for telehealth than in-person equivalent visits in 2020 and 2021. However, the difference was less pronounced in 2021 than in 2020. Payment variation also differed when looking at individual commercial payers, with some having larger gaps in payments than others.

To understand denied claims, CIVHC evaluated information submitted outside the CO APCD by four large commercial payers. The analysis showed that telehealth services were denied more often than in-person visits, with the majority of telehealth visits denied because of untimely filings.

“There are many reasons why Coloradans may not use telehealth services including lack of technology, general comfort level, and inability to find providers offering telehealth services. And if providers can’t financially sustain offering telehealth services, they can’t offer that benefit to their patients,” remarked Stephanie Pugliese, Director of OeHI. “These analyses guide our efforts to address prevalent barriers, with the ultimate goal to ensure all Coloradans have the ability to benefit from telehealth.”

CIVHC and OeHI are working together to develop new analyses in the future that will help continue to inform and expand telehealth use in Colorado. For more information about CIVHC’s analyses, contact, and for more information about OeHI’s telehealth work, contact

Report Resources:

* The CO APCD data does not contain Veterans Affairs health care claims which artificially lowers the telehealth visit rate in areas with high concentrations of Veterans which may be using the VA health care system for care.  As a result, correlation data for percent of households with Veterans must be interpreted with caution.