Virtual physician services advance equitable care in US territories

More than 4 million U.S. citizens reside in the U.S. territories — Puerto Rico, Guam, the U.S. Virgin Islands, American Samoa, and the Northern Mariana Islands. Despite their citizenship, these Americans experience significant health care disparities. From limited hospital access and physician shortages to geographic isolation and disaster vulnerability, the health care infrastructure in these areas falls short of what is needed. Virtual physician services (VPS) — a telehealth solution that emphasizes real-time physician reimbursement —offers a sustainable strategy to improve care equity, access, and system resilience.

The unique health care challenges of US territories

Compared to the mainland, U.S. territories have far fewer hospitals and physicians per capita. Puerto Rico has only 71 hospitals for a population of 3.2 million. Physician shortages are especially severe, with Guam reporting 1.8 doctors per 1,000 people — well below the U.S. average of 2.6. Inadequate broadband coverage and high poverty rates further limit health care access. For example, 43 percent of Puerto Rico’s population lives below the poverty line, and only 60 percent of households have high-speed internet. These disparities translate to higher rates of diabetes, lower life expectancy, and increased infant mortality.

Why virtual physician services matter

Over the past decade, the federal government has invested $30 to 50 million in telemedicine hardware for these territories, but outcomes have been limited. Equipment alone doesn’t deliver care — clinicians do. VPS shifts the focus from hardware to services by tying funding directly to physician encounters. This approach ensures higher adoption, financial sustainability, and measurable outcomes.

Benefits of VPS include:
 - Connecting patients to mainland specialists without the burden of travel
 - Managing chronic diseases through remote monitoring tools
 - Ensuring care continuity during disasters such as hurricanes and typhoons
 - Enhancing provider retention by making remote practice financially viable

Real-world results: What VPS can deliver

After Hurricane Maria, Puerto Rico saw a 20 percent drop in emergency visits in rural areas thanks to VPS-based virtual primary care and mental health services. In Guam, the VA’s telehealth program boosted mental health access for veterans by 30 percent. Alaska’s mature telehealth network, which reduced specialist wait times by 25 percent, serves as a scalable model for other rural and insular populations.

What’s holding VPS back—and how to move forward

Despite its promise, VPS adoption faces several challenges:
 - Inconsistent broadband coverage, especially in American Samoa and the Northern Mariana Islands
 - Fragmented reimbursement policies and lack of Medicaid parity
 - Cross-jurisdiction licensure barriers for mainland providers
 - Limited digital literacy and cultural factors that prefer in-person care

Policy recommendations include:
 - Offering a $50 reimbursement per VPS encounter over a 36-month period to jumpstart adoption
 - Requiring territories to join the Interstate Medical Licensing Compact
 - Implementing payer parity laws to align private insurer rates with CMS reimbursement
 - Investing in multilingual telehealth platforms and training to increase digital inclusion

The ROI of VPS

Assuming 500,000 VPS encounters annually, a $50 reimbursement incentive would cost $25 million but yield $100 million in savings. This 4:1 return comes from reduced hospitalizations, fewer medical evacuations, and improved chronic disease management. In a time of tight budgets, VPS represents both a fiscally responsible and morally necessary investment.

Equitable access for all US citizens

U.S. territories deserve a health care system that is as strong and accessible as that of the mainland. Virtual physician services offer a scalable, high-impact solution for closing long-standing gaps in care. With targeted policy support and sustainable reimbursement, VPS can reshape health care delivery for the better — ensuring that no American is left behind because of where they live.

NRHA adapted the above piece from Innovator Health, a trusted NRHA partner, for publication within the Association’s Rural Health Voices blog.

About the author: Darren Sommer, DO, MBA, MPH, is the founder and CEO of Innovator Health. With over 30 years of combined military, academic, and clinical experience, he is a national leader in rural telehealth innovation.