Telehealth patients did not require more follow-up care than in-person patients, according to a new study published in JAMA Network Open—and experts suggest that these findings may help shape telehealth policies going forward.
Study details and key findings
For the study, researchers analyzed data from 40.7 million U.S. adults who were insured through Blue Cross and Blue Shield Association health plans between July 1, 2019, and Dec. 31, 2020. Health care visits among participants were measured from July 1 to Dec. 31, 2020, and compared with visits during the same period in 2019. A logistical regression model was used to determine telehealth's association with care outcomes.
Overall, researchers found that all health care encounters decreased by 1%, and in-person encounters per enrollee decreased by 17% from 2019 to 2020. During that same period, telehealth encounters increased from 0.6% to 14.1%. The highest telehealth usage was among adults ages 18 to 34 (25.3%), followed by adults ages 35 to 49 (19%).
When it came to follow-up care, patients being treated for acute conditions through telehealth were as likely or slightly more likely to need a follow-up visit as patients being treated through in-person care. Telehealth patients with acute respiratory infections were more likely to require follow-up care than in-person patients, but researchers noted that this may be due to Covid-19 concerns.
In comparison, telehealth patients with chronic conditions, such as hypertension or heart failure, were less likely to require follow-up care than in-person patients.
In addition, telehealth patients had slightly higher diagnostic severity than in-person patients. Compared with 7.4% of in-person encounters, 10.1% of telehealth patients had a disease severity of 2 based on comparable 3-digit ICD-10 disease categories.
According to Modern Healthcare, these findings may help policymakers understand the efficacy of telehealth as they consider how to develop related policies after the Covid-19 pandemic ends.
"Telehealthcare is comparable to in-person care and it really is not a duplication of the service," said Elham Hatef, an assistant professor at Johns Hopkins University and one of the study's authors. "That might help policymakers to consider the continuation of insurance coverage for telehealth services."
Because the study focused on commercially insured patients, its findings may not be applicable to Medicare beneficiaries, who are typical older and less healthy. Going forward, Hatef said researchers should examine telehealth follow-up care trends for Medicare and Medicaid beneficiaries.
In addition, Hatef suggested researchers study clinical outcomes for different patient populations that used telehealth during the pandemic, as well as the rates of follow-up visits after December 2020. Since the Covid-19 vaccine became available in 2021, they may have impacted care outcomes.
According to Krista Drobac, executive director of the advocacy group Alliance for Connected Care, the study's finding that telehealth reduced the chance of a follow-up visit for patients with chronic conditions may be important for Medicare beneficiaries. Research from the Commonwealth Fund suggests that around 30% of traditional Medicare beneficiaries have six or more chronic conditions.
"What we're most interested in is impact on Medicare," Drobac said. "If the researchers found lower rates of follow up for chronic conditions, that might mean that telehealth in Medicare will yield lower overall follow up because more seniors have chronic conditions."
In March, lawmakers in Congress passed a 151-day extension on pandemic-era telehealth policies, but progress has been limited, Modern Healthcare reports. However, Sen. Joe Manchin (D-W.Va.) on Tuesday said a telehealth bill he co-authored is gaining interest.
"We're moving on that again, but it's all intertwined with internet connectivity so we have to move in that direction," Manchin said. (Goldman, Modern Healthcare, 4/26; Hatef et al., JAMA Network Open, 4/26)