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January 5, 2022

Is the pandemic-era telehealth boom reversing?

Daily Briefing

    Although telehealth use surged in 2020, a new analysis by Trilliant Health found that utilization saw a significant dip in 2021—even as many health experts continue to push for expanding telehealth coverage in the future.

    Telehealth usage dips significantly after rapid growth in 2020

    According to a report released in December by HHS' Office of the Assistant Secretary for Planning and Evaluation (ASPE), telehealth use increased 63-fold among Medicare beneficiaries from 2019 and 2020.

    Overall, ASPE 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 use, 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."

    However, a recently published analysis by Trilliant Health found that telehealth use decreased by an average of 40.3% a month in 2021 compared to 2020. For the analysis, the company compared telehealth usage in commercial, Medicare Advantage, and Medicaid manage care claims during March to December 2021 with the same period in 2021.

    Among all U.S. states, according to the analysis, South Dakota (60.2%), Wyoming (59%), and Mississippi (57.9%) saw the largest decreases in telehealth use from 2020 to 2021. In comparison, New Mexico (24.9%), Oregon (25.6%), and Arizona (25.9%) saw the smallest decreases in utilization.

    What might be next for telehealth

    According to Modern Healthcare, many health care professionals continue to push for expanded telehealth coverage, arguing that it will improve patients' access to care—particularly for behavioral health conditions.

    For example, Marc Harrison, president and CEO of Intermountain Healthcare, wrote in the Harvard Business Review that greater telehealth usage will help the health care industry "meet people where they are as much as possible when delivering care."

    Using telehealth effectively can help patients "remain in their communities, surrounded by their support systems, with the local hospital retaining most of the compensation," Harrison wrote. "That strengthens not only rural hospitals but also rural communities where the hospitals are often the largest employers."

    Separately, CMS previously said it would use ASPE's report to help determine its future telehealth policies. "[The ASPE] 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." (Devereaux, Modern Healthcare, 1/3; Jain, Trilliant Health, 12/12/21; ASPE research report, 12/2021)

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    Advisory Board's take

    Telehealth is here to stay. Here's how to assess your organization's future usage.

    Jordan AngersBy Jordan Angers

    Telehealth is still stabilizing from its massive explosion in 2020, so the decline in utilization makes sense. For most of 2020, telehealth was the only option for receiving and delivering care. As in-person care opened back up and people were ready to return to in-person interactions, it’s natural that some of those telehealth visits would convert to in-person visits. But it’s important to acknowledge that telehealth volumes are still dramatically higher than anything we experienced before Covid-19, even after the decline in 2021. This suggests that telehealth is here to stay in some capacity.

    What will the future look like?

    The short answer is that it depends on how health care leaders choose to use telehealth over the next year.

    We know that telehealth volumes have been the industry’s focus over the past two years. We’ve seen many sources reporting on telehealth as a percentage of total visits and telehealth volumes across specialties. While utilization data is important and a helpful guide for decision-making, we continue to see that organizations recognize value in how they use telehealth rather than how much telehealth they do. Luckily, the explosion of telehealth during Covid-19 gave us data across different use cases to help us understand where telehealth has the biggest impact. For example, it’s clear that telehealth works well for behavioral health in the long-term, not just as an emergency substitute for in-person care.

    Tactics for telehealth usage

    We encourage you to consider which visits should be virtual rather than how many virtual visits you should be doing. Here are some tactics to consider:

    • Use telehealth as a tool to achieve organization-wide goals. Telehealth isn’t a new type of care—it’s a tool that can help organizations improve care delivery and meet strategic goals. Just like any other tool, telehealth won’t be the right tool for every situation. Consider how telehealth can help advance strategic goals such as increasing access to specialists or moving towards value-based care.
    • Ask what patients and physicians want from telehealth. You need both parties on board for telehealth to be successful long-term. So, think about where telehealth can provide value to patients and physicians, and how it can improve their experiences of seeking or delivering care.

    Of course, there are many competing priorities when it comes to investing in telehealth. And outstanding questions about reimbursement and regulations make prioritizing especially difficult. Here are four questions to help get you started:

    • What is our unmet need? What can’t we do and how will telehealth help us meet that need?
    • Do we already have something that can do this job? Do we need to consider other telehealth modalities like remote patient monitoring (RPM) or asynchronous capabilities?
    • Do we need to build this ourselves, or partner or buy a solution? Do we have enough physicians to staff our telehealth platform, or will we need to outsource to a third-party vendor?
    • What the downstream implications of investing in telehealth? How will we reinvent care standards and pathways for telehealth? How will scheduling, clinical documentation, and training and quality requirements need to change?
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