Telemedicine, or the provision of health care services at a distance by means of telecommunications technology, can improve access to care by bringing medical care into communities with limited access to providers or facilities, reduce wait times, and improve convenience. However, when telemedicine is offered in safety-net settings, it tends to be a low-volume service. To explore this issue, the California Health Care Foundation invested in the Sustainable Models of Telehealth in the Safety Net (SMTSN) initiative, which was in place from 2017 to 2020 and provided funding for telemedicine staff for 24 months. RAND researchers evaluated the experiences of health centers that participated in the initiative. Although the SMTSN initiative and this evaluation occurred before the coronavirus disease 2019 (COVID-19) pandemic dramatically altered the regulation, reimbursement, and use of telemedicine services across the health care system in spring 2020, the findings presented in this report are relevant to health centers that are trying to rapidly expand telemedicine in response to the pandemic. Also, the barriers and strategies identified in the evaluation are likely to have ongoing relevance once some of the changes in place for the duration of the emergency are rolled back.
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