Exploring Racial and Ethnic Disparities in Telehealth Use: Implications for Digital Health Equity and Policy

The COVID-19 pandemic sparked a rapid transformation in healthcare delivery, accelerating the adoption of telehealth across the United States. While telehealth offered a lifeline to many patients during periods of restricted in-person care, concerns have emerged around equitable access and whether existing racial and ethnic disparities in healthcare have been exacerbated or alleviated by this digital shift.

A new study published in npj Digital Medicine (Fang et al., 2025) examines racial and ethnic disparities in telehealth utilization among Medicare beneficiaries. This large-scale analysis offers important insights for telehealth providers, digital health leaders, policymakers, and health equity advocates as they strive to design more inclusive and accessible digital health ecosystems.

Key Findings from Fang et al. (2025)

1. Persistent Disparities in Telehealth Use

The study analyzed Medicare claims data from over 6 million beneficiaries and found that Black, Hispanic, and Asian patients consistently had lower rates of telehealth utilization compared to White beneficiaries, even after adjusting for demographics, clinical characteristics, and geographic factors (Fang et al., 2025).

Contributing Factors

• Digital Divide: Limited broadband access and lower rates of digital literacy disproportionately affect communities of color, hindering their ability to participate in virtual care (Campos-Castillo & Anthony, 2022).

• Trust and Cultural Competency: Historical mistrust in healthcare systems, compounded by language barriers and culturally insensitive platforms, further reduces telehealth engagement among racial and ethnic minorities (Sanchez et al., 2021).

2. Specialty Care Disparities

The disparity was particularly pronounced in specialty care telehealth visits, with Black and Hispanic patients being significantly less likely to access virtual specialist consultations (Fang et al., 2025). This is especially concerning given that specialty care plays a crucial role in chronic disease management — conditions like diabetes, hypertension, and cardiovascular disease that disproportionately affect these communities.

Broader Implication

The findings suggest that telehealth isn’t closing the access gap for high-acuity or complex care needs, which could ultimately worsen health outcomes and increase downstream costs if early interventions are missed.

3. Audio-Only vs. Video Telehealth Utilization

Black and Hispanic beneficiaries were more likely to rely on audio-only telehealth visits compared to White patients, who more frequently engaged in video-based telehealth (Fang et al., 2025).

Source: Van Tulder, R. & Pfisterer, S. Creating Partnering Space. In Social Partnerships and Responsible Business: A Research Handbook 105 (2013).

Why This Matters

Audio-only visits, while helpful for expanding access in low-bandwidth areas, may limit providers' ability to conduct thorough assessments or build rapport with patients. Policy proposals, including provisions in the Telehealth Expansion Act of 2025, seek to balance the importance of maintaining audio-only options while incentivizing technology improvements to expand equitable video access (Daines & Cortez Masto, 2025).

Policy and Practice Implications for Telehealth Leaders

1. Infrastructure Investment and Broadband Equity

To address these disparities, federal and state policymakers must prioritize broadband expansion in historically underserved communities. Programs like the FCC’s Affordable Connectivity Program are a start, but telehealth leaders should also advocate for health-specific broadband initiatives that support care delivery infrastructure (Federal Communications Commission, 2024).

2. Culturally Competent Telehealth Platforms

Digital health innovators can help close the gap by developing telehealth platforms with multilingual support, culturally relevant care pathways, and user-friendly interfaces designed for patients with low digital literacy (Sanchez et al., 2021).

Examples of Best Practices

• Offering real-time interpreter services embedded directly into telehealth visits.

• Designing interfaces with simple navigation, icon-based prompts, and mobile-first optimization.

• Building diverse clinician networks to match patients with culturally competent providers.

3. Data-Driven Equity Monitoring

Healthcare organizations should routinely analyze telehealth utilization by race, ethnicity, socioeconomic status, and geography to identify disparities within their patient populations (Institute for Healthcare Improvement, 2023). These insights can inform targeted outreach, education campaigns, and technology support programs to ensure equitable access across patient demographics.

4. Payment and Regulatory Considerations

Payers, including Medicare and Medicaid, play a central role in shaping telehealth adoption. Payment parity for audio-only services, coupled with incentives for broadband infrastructure investment, could help preserve access for vulnerable populations while encouraging investment in higher-quality video platforms (Centers for Medicare & Medicaid Services, 2024).

Key Takeaways for Digital Health Providers

• Racial and ethnic disparities persist in telehealth adoption, particularly for specialty care and video-based services.

• Digital health leaders must invest in culturally competent, user-friendly platforms to close equity gaps.

• Broadband access remains a critical social determinant of digital health equity, requiring ongoing policy advocacy and infrastructure investment.

• Telehealth utilization data should be routinely disaggregated by race, ethnicity, and socioeconomic status to identify gaps and opportunities for improvement.

• Policy reforms like the Telehealth Expansion Act could play a pivotal role in ensuring sustainable, equitable telehealth access for all.

Conclusion

Telehealth and digital health leaders have a critical responsibility to not only expand access but to ensure that historically marginalized communities benefit equitably from virtual care advancements. Addressing technological, cultural, and economic barriers will be essential for achieving true health equity in the digital age.

By combining policy advocacy, innovative platform design, and data-driven equity monitoring, telehealth leaders can help transform telehealth from a tool of convenience to a cornerstone of equitable, patient-centered care.

References

Campos-Castillo, C., & Anthony, D. (2022). Racial and ethnic disparities in telehealth use during the COVID-19 pandemic: A systematic review. Journal of Telemedicine and Telecare, 28(7), 507-518. https://doi.org/10.1177/1357633X211051944

Centers for Medicare & Medicaid Services. (2024). Telehealth services during and beyond the COVID-19 pandemic. Retrieved from https://www.cms.gov/newsroom/fact-sheets/telehealth-services-during-and-beyond-covid-19-pandemic

Daines, S., & Cortez Masto, C. (2025, February 27). Daines, Cortez Masto introduce bipartisan bill to protect Americans’ access to telehealth services. Retrieved from https://www.daines.senate.gov/2025/02/27/daines-cortez-masto-introduce-bipartisan-bill-to-protect-americans-access-to-telehealth-services-2/

Federal Communications Commission. (2024). Affordable Connectivity Program. Retrieved from https://www.fcc.gov/acp

Fang, T., et al. (2025). Racial and ethnic disparities in telehealth use among Medicare beneficiaries during the COVID-19 pandemic. npj Digital Medicine, 8, Article 15. https://doi.org/10.1038/s41746-025-01515-3

Institute for Healthcare Improvement. (2023). Achieving health equity: A guide for health care organizations. Retrieved from https://www.ihi.org/resources/Pages/IHIWhitePapers/Achieving-Health-Equity.aspx

Sanchez, T. H., et al. (2021). Barriers to telehealth engagement among racially and ethnically diverse populations. Journal of Health Care for the Poor and Underserved, 32(4), 1805-1820. https://doi.org/10.1353/hpu.2021.0167