Achieving health equity (where every person has the opportunity to attain their full health potential) requires the removal of obstacles to health, including barriers to high-quality medical care. Innovations in service delivery can inadvertently maintain, worsen, or introduce inequities. As such, implementation of innovations must be accompanied by a dual commitment to evaluate impact on marginalized groups and to restructure systems that obstruct people from health and healthcare. Understanding the impact innovations have on access to high-quality care is central to this effort. In this Perspective, we join conceptual models of healthcare access and quality with health equity frameworks to conceptualize healthcare receipt as a series of interactions between people and systems unfolding over time. This synthesized model is applied to illustrate the effects of telemedicine on patient, population, and system outcomes. Telemedicine may improve or worsen health equity by altering access to care and by altering quality of care once it is accessed. Teasing out these varied effects is complex and requires considering multilevel influences on the outcome of a care-seeking episode. This synthesized model can be used to inform research, practice, and policy surrounding the equity implications of care delivery innovations more broadly.

On January 20, 2020, authorities reported the first US case of coronavirus disease 2019 (COVID-19) in Snohomish County, Washington. By March 11, the World Health Organization declared a global pandemic, and on March 13, the US declared a national emergency. On March 18, the American Academy of Pediatrics issued guidance suggesting that pediatricians limit preventive care visits to younger children requiring immunization, separate the well-visit and sick-visit spaces and times, and increase telehealth capacity. Following Medicare’s lead, many Medicaid programs and other payers expanded coverage and relaxed stipulations about telehealth use. In-person visit volumes in pediatric primary care practices plummeted, and many practices initiated or dramatically expanded video visits to reach patients and attempt to maintain financial viability. Within weeks, primary care practices and the families they serve had widely adopted virtual primary care.