Telehealth's Pandemic Surge: Progress Achieved, Yet Challenges Persist

The growing use of telehealth by health care providers could be considered a more positive impact of the COVID-19 pandemic, but several challenges persist.

The COVID-19 pandemic accelerated the adoption of telehealth nationwide, revealing significant benefits while also exposing ongoing challenges. | Image Credit: Nattakorn - stock.adobe.com

Pre-Pandemic Telehealth Use

Telehealth, meaning receiving medical care remotely via synchronous, asynchronous, or store-and-forward technology, has steadily increased in the US over the past decade.¹ Growth remained slow until March 2020, or the beginning of the COVID-19 pandemic. Before March 2020, telehealth integration remained low, and the logistics were complex.

For example, providers dealt with various rules about which prescriptions, visit types, and patient types were acceptable. However, as of 2018, 76% of US hospital systems used telemedicine, mostly in the radiology, cardiology, and psychiatry sectors.

The overall response of patients with access to telehealth before March 2020 was positive. Their responses were influenced by various factors, including improved outcomes, ease of use, low cost, better communication, and eliminated travel time. Despite this, patients also expressed some concerns, like data security.

Clinicians had more mixed opinions on telehealth. In a past study, about half of clinicians who used both telehealth and in-person visits said the personal connection through telehealth was inferior to in-person visits. About one-third of them also stated that the overall visit quality was better in person. Those against telehealth were also concerned about equipment costs, the liability potential, inadequate reimbursement barriers, and the lack of training.

Pandemic Telehealth Use

After the COVID-19 pandemic began in March 2020, many barriers to telehealth were lifted; patients could not go to in-person office visits since they were quarantined or sheltering as directed. Consequently, Congress majorly altered Medicare restrictions on where telehealth must originate, what platforms could be used, and what could be reimbursed. Similar relaxations then impacted telehealth reimbursements and interstate practice and privacy regulations.

Therefore, practices expanded telehealth services during the months of sheltering in place and recurrent COVID-19 surges. As a result, patients' use of telehealth services significantly increased. A study involving 36 million working-age patients with private insurance claims data showed that telehealth use increased by 766% in the first 3 months of the pandemic, from 0.3% of all interactions from March to June 2019 to 23.6% in the same period.³

Despite the rise in telehealth use, US medical care declined overall during this time. Using claims data from 16.7 million commercial insurance and Medicare Advantage patients, one study estimated that total outpatient visits fell by 30% of usual volume between January and June 2020; telehealth only compensated for about two-thirds of this loss.⁴ Additionally, 80% of physicians surveyed by the American Medical Association (AMA) reported an average reported income decrease of 32% 5 months into the pandemic.¹

Post-Pandemic Telehealth Use

Although isolation precautions and shelter-in-place orders have largely been lifted, telehealth has shown that it is here to stay. Despite in-person care being chosen most of the time, FAIRHealth, which manages a large national database of Medicare and private claims data, found that telehealth claims have risen from 0.1% in 2019 to around 5% at the end of 2021.

Telehealth use in the post-pandemic era was discussed in a recent interview with The American Journal of Managed Care^® inlcuding Sreekanth Chaguturu, MD, chief medical officer of CVS Health; Cathy Moffitt, MD, FAAP, CHIE, chief medical officer of Aetna; and Joneigh Khaldun, MD, MPH, FACEP, chief health equity officer of CVS Health.²

Even with brick-and-mortar practices reengaged in many places nationwide, Moffitt noted that Aetna and CVS Health members like virtual care solutions, as indicated by patient satisfaction scores. Through telehealth, members can access physical and mental health care services from their homes or work. Therefore, it especially benefits those with transportation challenges who have trouble traveling to in-person appointments and those who cannot take time off work to see a doctor.

Also, Moffitt explained that telehealth services especially help the over 80 million individuals in primary care deserts without brick-and-mortar primary care providers. Consequently, she noted that several members said they would not have received primary and preventive care services if they had not done so through CVS Health’s telehealth services.

Chaguturu added that the telehealth services helped CVS Health to create omnichannel experiences, meaning members can see a physician virtually or physically, when possible. Therefore, members can do a virtual visit or convert it into an in-person appointment when necessary.

In-person appointments can be conducted at one of CVS Health’s MinuteClinic locations or another health care provider. Chaguturu noted that CVS Health uses Epic to store and share patients’ electronic medical records, so their information will travel with them regardless of where they are treated.

Although telehealth helps break down some care barriers, Khaldun noted there are still challenges with telehealth visit access. For example, patients may have digital literacy challenges, meaning they are unsure how to use a computer or the program necessary for the virtual visit. Additionally, not all patients have reliable internet access or a private area to conduct a telehealth visit.

“I think there are many opportunities to expand access to care with telehealth,” Khaldun said. “Also, just being mindful of some of the challenges and, again, making sure we’re not leaving anyone out of those opportunities that telehealth provides.”

References

1. Shaver J. The state of telehealth before and after the COVID-19 pandemic. Prim Care. 2022;49(4):517-530. doi:10.1016/j.pop.2022.04.002 

2. McCormick B. Building trust, breaking barriers: health care leaders tackle primary care challenges. AJMC. August 8, 2024. Accessed August 30, 2024. https://www.ajmc.com/view/building-trust-breaking-barriers-health-care-leaders-tackle-primary-care-challenges

3. Weiner JP, Bandeian S, Hatef E, Lans D, Liu A, Lemke KW. In-person and telehealth ambulatory contacts and costs in a large US insured cohort before and during the COVID-19 pandemic. JAMA Netw Open. 2021;4(3):e212618. doi:10.1001/jamanetworkopen.2021.2618

4. Patel SY, Mehrotra A, Huskamp HA, Uscher-Pines L, Ganguli I, Barnett ML. Variation in telemedicine use and outpatient care during the COVID-19 pandemic in the United States. Health Aff (Millwood). 2021;40(2):349-358. doi:10.1377/hlthaff.2020.01786