Telehealth looks to be heading in the same direction as Billy Bean’s career. Not the Money Ball general manager who innovated the use of data and analytics to maximize on-field success, but Billy Bean the great baseball player prospect who never fulfilled expectations.
The Current State of Telehealth
Prior to COVID, telehealth existed almost in name only, accounting for <1% of primary care visits. This quickly changed in the weeks following the start of COVID jumping to just over 25% of total patient interactions. The adoption of telehealth was primarily driven by the stay-at-home phase of COVID. From Q1 2020 to Q1 2021 telehealth usage jumped nearly 600%. Once the world “opened” up again patients returned in-person and telehealth became supplemental. While usage as of Q1 2022 is still ~430% greater than pre-COVID it has contracted ~23% vs Q1 2021.
Analyzing the physician-patient relationship, a high correlation (.99) is observed. From 2019 to 2021 the growth in the number of physicians using telehealth was an astonishing +2200% which outpaced the growing in-patient numbers by +30%. The result is a declining patient/physician ratio which suggests telehealth has progressed along the lifecycle curve, moving from innovators in 2019 quickly through early adopters and onto the mass market.
Primary Care remains the largest user of telehealth from an absolute patient volume perspective but only accounts for ~7.5% of patient interactions. Conversely, psychiatrists are the biggest adopters as telehealth currently (Q1’22) accounts for ~42.5% of total patient interactions. Further, psychiatrists only had an 8% decline in patient volumes vs the same time in 2021, which is 3x less than primary care’s 24% decile. Based on these trends we can expect that telehealth will remain a key part of mental health care.
Climbing the Hill
Telehealth faced an uphill battle prior to COVID. In addition to technical and intimacy challenges, there were financial barriers to reimbursement. During the peak of COVID, adjustments were made to reimbursement that brought payments into line with office visits.
A recently published study overseen by John Hopkins University found exponential growth in the use of telehealth that coincided with changes in CMS reimbursement and the start of the pandemic. The authors noted that .42% of patients had at least one outpatient telehealth visit before the CMS changes and jumped to 9.97% after the changes to CMS reimbursement.
The new study also explored and found a greater increase in usage amongst the most disadvantaged neighborhoods. After data adjustments, it was found that the changes increased usage across the breath of socioeconomics factors. These findings are counter to prior studies which found disparities to exist between socioeconomic and age cohorts claims data.
The Role of Socioeconomics and HCPS
Analysis of MedFuse Real-World claims data with appended patient demographics including race/ethnicity and education, identified minimal disparities in telehealth usage among ethnic/racial lines. The only group that was consistently under-indexed in a meaningful way was the Black/African American segment, averaging 17 pts below the average of the four groups.
The inclusion of education in the analysis is a normalizing factor as a correlation between education and telehealth utilization is present. The data identified that patients with an associate's degree or above were more the 55% more likely to use telehealth than those with high school or less. Behaviors are normalized by layering education with ethnicity /race. The index gap for Black/African Americans compresses from an avg of 17 pts to as little as 3 pts in 2021. Similar disparities in telehealth utilization by education levels can be seen in other ethnic/racial cohorts with white/Caucasians demonstrating the greatest difference between those with an associate's degree and above vs high school or less.
What the Future Holds
With near-complete market penetration amongst physicians, the question is what is next for telehealth? Telehealth is something many people believe will be the future of healthcare. This is a reasonable expectation as advancements in technology and technology access continue to improve. In moving from where we are today to the future state, it is likely telehealth’s lifecycle development will go through a reset.
While COVID was most certainly a catalyst for adoption, what drove the usage during the early days of COVID will not be what drives the long-term success of this channel of care. During this period providers and patients will rediscover how telehealth can be used to enhance the patient journey. Whether telehealth will be Billy Bean the baseball player or the innovative Money Ball GM, cannot be determined just yet. Only time and the data will say for certain.
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