Telehealth is the use of electronic information and telecommunication technologies to support remote clinical healthcare, patient and professional health-related education, public health, and health administration. Currently millions of Americans are residing in areas with a shortage of primary healthcare providers and often experience delays to see a provider.[i] Telehealth is believed to improve access to healthcare for patients living in both rural and urban areas and ensure that patients receive the right care at a place and time most accessible to them. In addition, telehealth is also believed to reduce healthcare costs by:
- Optimizing staff distribution and healthcare resources across healthcare facility or system
- Reducing unnecessary office and emergency room visits and hospital admissions
- Reducing financial impact on providers in case of no-shows by patients.[ii]
Currently, 31 states and the District of Columbia have parity laws that mandate commercial insurers pay for telehealth services.[ii] Unfortunately, there are barriers to wide adoption of telehealth. For example, Medicare generally still limits coverage and payment for many telehealth services, lagging behind other payers. [iii]
We analyzed one of MedInsight’s client’s data for 2010-2017 with over 3.9 million Medicaid, Medicare, and Commercial plan members, to explore the use of telehealth services. We only explored those services recognized by federal and commercial health plans [iv] as billable for telehealth services.
Trends in telehealth use
We analyzed the data to study the utilization of telehealth services over 8 years and its distribution across different age groups and gender (Figure 1, Figure 2 and Figure 3). We observed that:
- Although the proportion of telehealth visits increased over recent years, it still remains well below one percent
- Over the years the average cost difference between telehealth and non-telehealth services has increased from almost nil to about $40 per visit with telehealth being cheaper than non-telehealth services
Figure 1: Trends in telehealth use
Figure 2: Average cost trend
- Females were found to have used telehealth more frequently as compared to males
- Members below 19 or above 64 years old were less likely to use telehealth services as compared to members 19 to 64 years old. This could be due to parental preference for their children, Medicare coverage limitations, or a matter of trust on the conventional methods amongst the older age groups.
Figure 3: Telehealth use across age groups and gender
Specialty based use of telehealth
Apart from analyzing the telehealth use by patients, we also analyzed the use across provider specialties (Figure 4) for the year 2017.
- The top ten specialties with highest number of telehealth visits constituted about 87% of the total telehealth visits
- Nurse practitioners were the most likely to use telehealth amongst all provider specialties followed by clinical psychologist and psychiatrist
Figure 4: Telehealth use by specialty
Clinical Classifications Software category based use of telehealth
Instead of analyzing data at the individual diagnosis level, we compared the telehealth use for the year 2017 at the Clinical Classifications Software (CCS) category[v] level, (Figure 5) which provides a method for classifying diagnoses into clinically meaningful categories.
- The top ten CCS categories with highest number of telehealth visits constituted about 82% of the total telehealth visits
- Nine out of the top ten CCS categories were related to mental health and behavioral disorders. This is in line with the top ten specialties with maximum telehealth use
- Overall, telehealth constituted below 2% of all included services, the rest being accounted by other type of visits
Figure 5: Telehealth use by CCS diagnosis category
Although the analysis was based on limited administrative data, it illustrated that telehealth is a far less expensive option in comparison to the conventional face-to-face visits. Even a one percent shift from face-to-face visits to telehealth can save millions of dollars. However, members, payers, and providers need to start embracing telehealth as effective as any other form of healthcare service delivery method.
[i] Telehealth Programs, Health Resources and Services Administration. Available at: https://www.hrsa.gov/rural-health/telehealth/index.html
[ii] Jamal H. Mahar, MD et al. 2018. Telemedicine: Past, present, and future. Available at: https://www.mdedge.com/ccjm/article/189759/practice-management/Telehealth-past-present-and-future
[iii] American Hospital Association. Fact sheet: Telehealth. Available at: https://www.aha.org/system/files/2019-02/fact-sheet-telehealth-2-4-19.pdf
[iv] United Healthcare, telehealth and telemedicine policy. Policy Number: ADMINISTRATIVE 114.32 T0. April 2019. Available at: https://www.uhcprovider.com/content/dam/provider/docs/public/policies/index/oxford/telemedicine-ohp.pdf