3 Things COVID-19 Taught Us About Telehealth

And what the data says about its strategy going forward

Since its onset in March 2020, COVID-19 caused a major spike in telehealth across the nation.

The healthcare industry pivoted rapidly in response to stay-at-home orders and social distancing by approving new payment models and shifting to providing care via phone and video visits at increased rates.

Many organizations witnessed a steep increase in overall telehealth utilization between March and December 2020. However, as we start to reopen and resume pre-pandemic activities, some telehealth services are slowly starting to dwindle while others are converting almost entirely back to in-person.

Everyone wants to know: is telehealth here to stay?

In this case study, we used our Health Intelligence Dashboard to analyze an anonymized payer’s telehealth claim trends. We examined which services and conditions were most widely adopted for telehealth between March and December 2020 and variation in adoption by neighborhood, demographics, and disease states.

This case study is certainly not exhaustive, and is meant to be a catalyst for discussion about how organizations might examine their own telehealth data, what insights it can provide, and begin planning an ongoing telehealth strategy for 2021 and beyond.

Here are three things our data taught us about telehealth in 2020:

1. During the pandemic, the role of telehealth became more critical and has set us up for a new normal.

Since COVID hit, telehealth claims are cited to have increased by over 8,000 percent nationally. For example, in April 2019, telehealth accounted for only 0.15% of all medical claim lines, but in April 2020, telehealth jumped to 13% across the country.

We also saw tremendous jumps in utilization at hyper-local levels. When we examined the telehealth trends from our anonymized client case study, which comes from a payer in New Mexico, we see that telehealth visits peaked in April 2020, with another spike in the final quarter of the year (as COVID-19 resurged).

It intuitively makes sense that telehealth peaked when transmission of coronavirus was highest, incentivizing more people to avoid public spaces and seek alternative methods for important care they needed. But new policies also made it easier for patients to receive care through telehealth during the pandemic. Going forward, while there is still quite a bit of variation between state reimbursement policies, government at the federal level is signaling continued support for telehealth.

Efforts to improve health equity, remove barriers to care, and better serve vulnerable or rural populations often promote the benefits of telehealth approaches to care, and our data shows a particular application of telehealth for behavioral health conditions.

With broader telehealth adoption, increased coverage, and a focus on expanding access to care, it appears that we are trending toward a new normal.

But…

#2. Telehealth isn’t for everything.

Our first graph shows how this payer’s telehealth visits were split between behavioral health and physical health. Looking further into our case study data, we can drill down into our Health Intelligence Dashboard to view the top specialties, diagnoses, and procedures that occurred via telehealth rather than in-person.

The next three charts shed insight into the services and conditions that appear to be more widely-adopted and services candidates to persist for telehealth delivery post-pandemic.

Again, it’s important to note that the data are specific to only one payer and are not representative of national aggregate trends for other payers or providers.

Behavioral health specialists were the most prevalent provider type submitting telehealth claims:

However, it appears that not all behavioral health conditions are represented among telehealth utilization at the same rates, such as Schizophrenia. This could indicate an important gap in the delivery of telehealth or that patients with certain conditions may not adopt telehealth as easily as others:

Follow-up office visits for established patients were largely being held virtually, but we found that telehealth is not utilized as often for new patients’ initial visits:

What these charts show is that telehealth can only go so far; there is only so much that can be done via video and phone. We are hearing from a lot of providers who are starting to look beyond “just telehealth” by pairing virtual visits with digital health technologies, such as devices that record in-home vitals, or remote patient monitoring (RPM).

RPM devices collect data and monitor vitals of patients from within their home through digital tools like blood pressure cuffs, oxygen sensors, fitness trackers, CPAP machines, etc. That data can be sent to the doctor who can then provide a much more robust, real-time, and informed telehealth visit.

While the combination of digital health devices and telehealth suggests the possibility for a broader coverage of services and diagnoses available for virtual visits, there are still questions about where to focus these efforts and for what specific disease states. For example, should this approach focus on patients managing diabetes, hypertension, other conditions?

#3. Social determinants of health and demographics matter in telehealth.

Talking to medical groups, many expressed an expectation early into the pandemic that a younger demographic would be more likely to use telehealth. But our payer case study shows otherwise — we actually saw all age groups using telehealth in 2020. For older adults, this could be in part due to a higher reluctance to make in-person visits.

To further evaluate how telehealth utilization varies between demographics as well as socioeconomics and other determinants of health, we can zoom in on specific geographic regions in our Health Intelligence Dashboard. In this case study view, we saw that neighborhoods with higher average incomes showed more frequent and repeat utilization of telehealth, and urban use outperformed rural communities on both a raw and per 1000 basis by enrollment county.

These findings are just scratching the surface.

There are many ways to slice and dice the data: by age, income, chronic conditions, population density, travel patterns and travel distance, et cetera. We must understand who is using telehealth, why, and how often, if we are to understand the implications going forward: informing policy, planning strategy, and measuring outcomes.

Key challenges and considerations for creating telehealth strategy into 2021.

The market is starting to indicate where people are putting their money, like recent developments with MDLive and Livongo/Teledoc. There will also be insights found that we haven’t recognized yet, or maybe we don’t have the data yet, but data and trends will continue to emerge.

With 2020 telehealth utilization data under our belts and in hand, now is the time to start exploring questions like:

• Who is most likely to continue using telehealth into the future, and for what?
• Do the “benefits” outweigh the “costs” of telehealth, and how do we measure that?
• Which services should be carried forward via Telehealth?
• What happens if reimbursement and parity changes after the emergency orders?
• And more importantly, will telehealth have a measurable impact on outcomes, whether that’s improved outcomes in quality, satisfaction, or costs?

The next steps.

Our colleagues and clients are already working on the next step and developing targeted programs to address the needs of their communities by overlaying this kind of cost, utilization, and health history data with additional Determinants of Health indicators such as disease prevalence, socioeconomic trends, behavioral and social infrastructure analytics, travel/mobility patterns, environmental conditions, and gaps in provider access, among others.

Our data models are being fine-tuned to recognize telehealth as an emerging modality of care rather than a service outlier, to identify new and emerging billing patterns, and to isolate those who would benefit from telehealth (and those who will still need to be touched in some other way).

Stefany Goradia is VP of Health Analytics at the RS21 Health Lab, a data science firm and Inc. 500 fastest-growing company headquartered in Albuquerque, New Mexico. Ms. Goradia helps merge disparate and non-traditional data with complex health and healthcare data to analyze key drivers of healthcare costs and variation, surface insights across multiple sources of information, and help eliminate guesswork from strategic decision making. Formerly, Ms. Goradia held analytics and technical roles at healthcare organizations across New Mexico before co-founding Versatile MED Analytics in 2017, a healthcare analytics and business intelligence startup which was acquired by RS21 in 2021 to form a new Health Lab division. She is now responsible for RS21 Health Lab’s data tools, analytics development, and overseeing product and services delivery for clients — which exclusively includes health and human service applications in AI and data science, data-first software and web development, and big data engineering.

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