Telehealth begins to fulfill its promise
By Lia Taniguchi | September 27, 2022
Prior to the COVID-19 pandemic, telehealth accounted for only .4 percent of all visits, according to athenahealth’s network data. That proportion grew dramatically at the start of the pandemic when care was shifted remotely to slow the spread of COVID-19, with virtual visits accounting for approximately 12.1 percent of all visits during the spring months of 2020. As the pandemic progressed, patients and providers returned to in-person care, but virtual care has remained popular: 8.9 percent of all care was virtual in the first half of 2022.
Telehealth extends and strengthens the continuum of care
Early in the pandemic, telehealth largely served as a substitute for in-person appointments deemed too risky. As time passed, healthcare organizations learned much about how and when telehealth is most effective. Patients using telehealth had an average of 3.8 more annual visits in 2020 and 2021 than those who did not see clinicians virtually. They were also more likely to receive a new diagnosis at a telehealth appointment than a patient seen in person--on average 88.3 percent more likely to receive a mental health diagnosis and 35 percent more likely to receive some common physical health diagnoses (like hypertension), though the physical health difference has been declining since 2020. Those with new physical health diagnoses were also more likely to have an in-person follow-up after their telehealth appointments.
Higher utilization may not initially seem like a positive development, but the patterns of care suggest that telehealth is being used as an important diagnostic and triage tool, directing patients to the right care setting, possibly reducing reliance on expensive venues like emergency rooms and urgent care by offering easier access to same-day appointments and offering a gateway to tailored, efficient in-person care.
Patients also used telehealth to seek out new mental health support to a degree not previously seen, with telehealth appointments accounting for 1.8 times more new mental health diagnoses than in-person visits. And in a 2,000-patient survey commissioned by athenahealth in 2022, 23 percent of respondents indicated they were more likely to seek out mental health services because telehealth is now an option. Overall, virtual mental health care seems to be filling a crucial gap in the continuum of care.
Higher utilization was also driven by patients with chronic conditions who were 88 percent more likely to adopt telehealth than non-chronic patients in 2022 and continue to be 56 percent more likely to use it in 2022. And 23 percent of survey respondents who used telehealth indicated that they used telehealth for scheduled check-ins related to chronic conditions, and another 9 percent used these appointments for ad hoc support also related to their chronic conditions. This could reflect a “care home” model in which these highest need patients get access to care when they need it, while consuming less in-person care overall and heading off potentially serious health incidents.
Telehealth doesn’t look the same for everyone
And, although Black and Hispanic patients are more likely to use telehealth overall (10.5 percent of Black, 21.9 percent of Hispanic, and 10.3 percent of white patients used telehealth in 2022), they are less likely to use telehealth to engage repeatedly with one consistent clinician or care team. Rather, the data suggest minority patients are more likely to use telehealth episodically, seeing whatever provider is available rather than one with whom they have an ongoing relationship.
“Based on our findings, we hypothesize that some patient populations who typically lean on in-person urgent care and ED settings are benefiting from the convenience of telehealth,” says Allison Roberts, PhD, MPH, athenahealth’s quantitative research manager, “However, when applied equitably, telehealth presents an opportunity to improve care coordination, provide more stable access to affordable care, and allow care teams to better collaborate. There’s a version of virtual care where patients and providers are more connected, better informed, and experience fewer barriers. That version is being modeled in some communities, but not all just yet.”
The promise of virtual care
While many providers and patients have found permanent use cases for virtual care, some pockets of the U.S. are still not engaging with virtual care or have not been able to integrate it into a comprehensive care delivery model. For virtual care to have a lasting place in healthcare, it must be equitably leveraged, regardless of geographic location, patient or provider demographics, or other factors.
As COVID-related legislative mandates around telehealth expire, like equal Medicare reimbursements for audio-only telehealth visits, equitable access and use becomes more difficult to achieve. State and federal policy needs to acknowledge the enduring role of telehealth and push for continued reimbursement parity and better internet infrastructure to support access to telehealth tools. Without such institutional support, it is unlikely that we will achieve equitable telehealth access and distribution of benefits.
"Telehealth is now a core tenet of healthcare delivery in the US,” says Greg Carey, director, regulatory and government affairs at athenahealth, “It is incumbent on Congress and the Administration to make permanent the flexibilities tied to the Public Health Emergency that have increased access for patients and provided appropriate reimbursement for a provider's clinical expertise. Failure to solidify these flexibilities would be a massive step backwards."
Telehealth offers many opportunities to continue to revolutionize the way care is delivered in the US. It allows care to move to less expensive venues, offers new modalities for patient-provider-communication, and increases convenience for both patients and providers. Ideally, these advantages should outlast the pandemic.
Virtual care has a permanent place in a connected healthcare ecosystem, so long as policy makers, clinicians, and patients can create and engage in an environment where telehealth benefits everyone. Ensuring that patients of all backgrounds are encouraged and able to use telehealth will provide the foundation for future technology-enabled care. Video and telephonic visits are just the tip of the iceberg when it comes to virtual care — remote patient monitoring, wearables, digital therapeutics, remote screening, medication adherence, and chronic condition management can all benefit from the virtual care revolution and find their place in integrated care delivery. And current trends indicate that revolution has already begun.
Additional contributions by Dani Bradley, senior manager Research & Insights