Daily Briefing

Who's using telehealth? Here are the top 5 diagnoses.

Telehealth usage surged during the pandemic, HHS reports, leading to tens of millions more visits since 2019. Here are the top five diagnoses made through telehealth in September—with one in particular dominating the rest.

Radio Advisory episode: The good and the (unintentionally) bad of virtual behavioral health investment

Telehealth use has surged during the pandemic

According to a new HHS report, telehealth use increased 63-fold during the pandemic. The report, which was prepared by HHS' Office of the Assistant Secretary for Planning and Evaluation, analyzed Medicare fee-for-service data for 34.9 million beneficiaries in 2019 and 2020.

Overall, the report found that Medicare telehealth visits increased from approximately 840,000 in 2019 to 52.7 million in 2020. In particular, behavioral health saw the highest telehealth utilization, increasing 32-fold from 2019 to 2020. Overall, visits to behavioral health specialists made up a third of all telehealth visits in 2020, compared with 8% of visits to primary care providers and 3% of visits to other specialists.

"During the Covid-19 pandemic, various telehealth flexibilities enabled patient access to their providers," said Rebecca Haffajee, HHS assistant secretary for planning and evaluation. "Pre-pandemic telehealth visits for Medicare beneficiaries went from hundreds of thousands to tens of millions, with many utilizing telehealth for the first time. [This] report offers a detailed data analysis on important trends for policymakers."

According to MedCity News, CMS will use the report to help determine future telehealth policies. "[The HHS] report provides valuable insights into telehealth usage during the pandemic," said CMS Administrator Chiquita Brooks-LaSure. "CMS will use these insights—along with input from people with Medicare and providers across the country—to inform further Medicare telehealth policies."

Telehealth flexibilities added during the pandemic will extend through Dec. 31, 2023 to give time for an evaluation, Healthcare Finance reports.

The top 5 telehealth diagnoses in September

Mental health conditions continue to be the top diagnosis in telehealth nationwide, Modern Healthcare reports. According to FAIR Health's "Monthly Telehealth Regional Tracker," which analyzes data from privately insured populations, mental health diagnoses made up 61.2% of all virtual care claims in September.

Krista Drobac, executive director of the Alliance for Connected Care, said telehealth services have likely made it easier for people seeking mental health services to access care, overcome stigma, and receive more consistent care—leading to higher use.

"There's none of the broader social perception that goes along with the challenges of people seeking mental health care," said Tom Kiesau, senior partner with the Chartis Group. "Historically, in a virtual setting, it is protected and private."

In addition, FAIR Health found Covid-19 fell out of the top five telehealth diagnoses nationwide between August and September. According to Drobac, this decrease in virtual Covid-19 diagnoses may be due to the fact that more people are now vaccinated and may be experiencing less acute symptoms.

Instead, the top five diagnoses made through telehealth in September include:

  • Mental health conditions
  • Acute respiratory diseases and infections
  • Developmental disorders
  • Joint/soft tissue diseases and issues
  • Substance use disorders

According to Kiseau, many patients may still be hesitant to return to in-person office visits, but have a high level of satisfaction with their care through telehealth. He added that health care facilities with the most flexibility for both in-person and virtual care will likely see more patient volume over time.

"Consumers ultimately dictate how business is delivered and transformed, based on their demands for convenience and for simplicity," Kiseau said. (Morse, Healthcare Finance News, 12/6; Reuter, MedCity News, 12/6; Broderick/Goldman, Modern Healthcare, 12/3; FAIR Health release, 12/6; Devereaux, Modern Healthcare, 12/6; FAIR Health Monthly Telehealth Regional Tracker chart, accessed 12/7)

Advisory Board's take

The biggest challenges (and untapped opportunities) for telehealth

Jordan AngersBy Jordan Angers

The explosion of telehealth utilization during Covid-19 provided the industry with a wealth of experience and opportunities to innovate with telehealth across different use cases.

It's clear that telehealth works well for behavioral health in the long-term, not just as an emergency substitute for in-person care. Even as overall telehealth volumes have plateaued, tele-behavioral health remains at peak levels, accounting for over 60% of all psychiatry visits. Much of the appeal of tele-behavioral health comes from its clear benefits to both patients and providers—patients feel comfortable using virtual modalities to connect with behavioral health providers, increasing access and opening up much needed capacity in the behavioral health space.

If 2020 was the tipping point for telehealth, and 2021 was an opportunity for health care providers to experiment with telehealth and learn valuable lessons, then 2022 is when they must address remaining challenges and explore untapped opportunities.

Three remaining challenges for telehealth

  1. Concerns about reimbursement jeopardize continued progress.

    Leaders are reluctant to invest further in telehealth programs because they worry that providers won't use telehealth in the absence of payment parity. Organizations that pursue value-based or risk sharing contracts fare better amongst the uncertainty of reimbursement.

  3. Cross-state licensing regulations restrict flexibility.

    The cross-state licensing regulations that were waived during the PHE are expected to come back into place. Restrictive cross-state licensing regulations turn state lines into arbitrary boundaries to care, preventing clinicians from caring for patients who travel or move to another state and making it difficult for patients to receive follow-up care from an out-of-state provider. Licensing regulations should reflect the realities of care, including the multi-state footprint of many health systems.

  5. Digital inequities exacerbate existing disparities in health care.
  6. Without proper implementation designs and policy considerations, there's a risk that the lack of broadband service and digital literacy will prevent telehealth's value from extending to the populations that would benefit the most from it. We've detailed the 'digital divide' in depth to help you understand what it may take to bridge the gap.

Untapped opportunities to explore

  1. Share lessons learned with colleagues.

    The majority of organizations stood up telehealth platforms over the past two years and have started to work out kinks in workflows and technology problems. Leaders should share these lessons with their peers across organizations so that the providers and patients across the country can continue to benefit from better telehealth experiences.

  3. Invest in other modalities to make telehealth work across the entire care journey.
  4. Virtual visits have been the focus during the pandemic as they acted as a replacement for in-person visits during nationwide lockdowns. But there's a limit to the value that virtual visits can provide in the long-term (like for visits that require physical touch). Other telehealth modalities like remote patient monitoring (RPM) and asynchronous capabilities can drive value for health systems by helping to retain patients, improve care outcomes, reduce total cost of care, and increase access and provider efficiency.







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