By John Commins
Telehealth accounted for one-in-four (24%) outpatient consultations among privately insured working-age adults during the first four months of the COVID-19 pandemic in 2020, up from 0.3% for the same period in 2019, a new study shows.
“Telehealth has been around for a long time, but the recent increase has been enormous,” said study lead author, Jonathan Weiner, DrPH, co-director of the Center for Population Health Information Technology and professor in the Department of Health Policy and Management at the Bloomberg School.
“These findings will not only help doctors and other clinicians plan for the future, they will also guide policymakers and technology companies, especially as we learn more about the challenges of accessing telehealth among older patients, the uninsured, and low-income patients,” Weiner said.
The study was published online Tuesday in JAMA Open Network.
The shift to telemedicine was prompted by the shuttering of many healthcare venues during the initial months of the pandemic for fear of transmitting the virus. At the same time, Weiner noted, insurance companies and the federal government were loosening restrictions on telehealth consultations to meet consumer demand.
The study analyzed Blue Health Intelligence-compiled claims data from 36.6 million private insurance plan members who were of working age and continuously enrolled during the study period.
A total of 15 million telehealth claims were submitted during the March to June 2020 study period, with 75% involving video, 9.2% using audio-only telephone, 3.3% conducted either by email or chat while 13% were unspecified.
Mental health was the top virtual consultation, with 46% taking place via telehealth, while 22% of medical consults were virtual.
In COVID-19 “hot spots” — states with a COVID-19 prevalence at least 1.5 times the national average – 36% of all consults were telehealth versus 21.6% in low COVID-19 areas. The study also found that the greater the COVID-19 prevalence in a specific ZIP code, the higher the use of telehealth.
About 24% of consultations in urban areas were via telehealth, compared to only 14% of visits from more rural settings. Age and number of chronic diseases were associated with more frequent telehealth consults, with individuals age 18 to 49 and those with more than two chronic conditions using telehealth the most.
The study also found that:
- Total overall total medical care costs, including hospitalizations, dropped 15%, from $358 to $306 per person per month, from 2019 to 2020. Persons with at least one COVID-19-related consult in 2020 had more than three times the medical costs compared to those with no COVID-19-related services–$1,701 per member per month versus $544, a difference of $1,157.
- In-person, outpatient visits decreased by 37%, from an average of 1.63 visits per enrollee during the three-month 2019 study period to an average of 1.02 visits per enrollee in 2020. However, since telehealth visits filled much of the gap, the total combined in-person and virtual encounter rate dropped only 18% between 2019 and 2020.
- For persons with at least one COVID-19-related insurance claim, the average number of in-person and telehealth consults were about 30% higher than the average number of claims for persons with no COVID-19-related visit. One-quarter of COVID-19-related consults were via telehealth versus 23% for non-COVID-19-related consults.
“Even though some of our findings are unique to the COVID-19 era, we need to consider what telehealth will look like beyond the pandemic,” Weiner said. “We will need to continue to assess and modify telehealth strategies to maximize value during this digital age, particularly given the challenges of the digital divide across social and geographic lines.”
John Commins is a content specialist and online news editor for HealthLeaders, a Simplify Compliance brand.