Increased Post-Pandemic Telehealth Services Yield Benefits for Patients and Providers

An increased adoption of telehealth services post-COVID-19 has led to better outcomes, increased health care spending, and lower hospitalization rates according to research published in Health Affairs.

Researchers examined the impact of greater telemedicine usage on health care utilization, spending, and quality across different health systems. In 2020, Medicare patients at health systems with high telemedicine use had significantly more telemedicine visits compared to systems with low use. In the following years, patients at systems with high telemedicine use saw a slight increase in outpatient visits and spending and improvements in medication adherence, without significant changes in hospitalizations or preventive care.

During the COVID-19 pandemic, researchers compared traditional Medicare patients' care at health systems that used more telemedicine versus those relying on in-person services. Patients were assigned based on care received in 2019 to address potential bias from prior clinician choices regarding telemedicine. Health systems were divided into quartiles based on 2020 telemedicine use to compare outcomes between 2019 and 2021-2022. 

A sensitivity analysis focused on 2022 outcomes to separate results from pandemic-induced changes in telemedicine use. Assessing care for all patients at health systems, not just telemedicine users, provided a more comprehensive understanding of the societal impact of expanding telemedicine coverage. The National Bureau of Economic Research's 2018 Health Systems and Provider Database helped identify health systems using multiple data sources like Centers for Medicare & Medicaid Services, American Hospital Association, and Medicare claims. Physicians were assigned to provider networks based on practice ownership.

Using a method based on Medicare's algorithm for attributing beneficiaries to accountable care organizations, patients were assigned to primary care practices based on their 2019 visits and spending. Of all the Medicare beneficiaries, 41% were assigned to a health system, with the remainder seeing physicians without a system affiliation. Health systems were categorized into quartiles of telemedicine use based on outpatient telemedicine visits per capita in 2020. A study cohort of beneficiaries with continuous enrollment in fee-for-service Medicare Parts A, B, and D from 2019-2022 with a primary care visit in 2019 were included in the analysis, with subgroup analyses conducted on patients with 3 chronic conditions and those with high frailty.

In 2019, over 5.5 million Medicare beneficiaries were assigned to health systems based on telemedicine use, with high-telemedicine systems being more prevalent in academic medical centers in the Northeast. Throughout 2020 and into 2022, patients at high-telemedicine health systems consistently received more telemedicine visits compared to low-telemedicine systems. Patients in high-telemedicine systems also saw increases in in-network visits and drug adherence while facing fewer non-COVID-19 emergency department visits. There were no significant changes in preventive care use or imaging tests between high- and low-telemedicine health systems. Overall, high-telemedicine systems experienced higher health care spending driven by inpatient admissions and pharmaceuticals.

“Given the small improvements in access and quality (in particular for chronic disease medications), combined with modest increases in spending along with patients’ and clinicians’ preferences, we believe that it will be difficult to justify a return to restricting telemedicine payment in Medicare,” said researchers. 

Reference
Nakamoto CH, Cutler DM, Beaulieu ND, et al. The impact of telemedicine on Medicare utilization, spending, and quality, 2019–22. Health Affairs. Published online ahead of print April 17, 2024. doi:10.1377/hlthaff.2023.01142