How Do Telehealth Outcomes Compare to In-Person Care?

In this Q&A, Elham Hatef, MD, health physician and clinical informatician, Johns Hopkins Center for Population Health IT, talked with Psych Congress Network about the results of her recent study “Outcomes of in-person and telehealth ambulatory encounters during COVID-19 within a large commercially insured cohort,” recently published in JAMA Network Open.

Given that there is a dearth of evidence about the outcomes for healthcare via telehealth versus in-person care, Dr Hatef and co-authors’ findings provide much-needed insight as clinicians across the healthcare sector discuss whether telehealth is here to stay. Below, Dr Hatef explains the study approach and results.

Read Part 2 of this Q&A series here!

Brionna Mendoza, Associate Digital Editor, Psych Congress Network: What prompted you and your colleagues to examine the outcomes of care in telehealth versus in-person encounters during the COVID-19 pandemic?

Elham Hatef, MD: ​the evidence on outcomes of care for telehealth vs. in-person care during the pandemic is scarce. While there are thousand studies reporting on telehealth during COVID there are few studies that have properly assessed the outcomes across a large population of patients. 

Mendoza, PCN: Please briefly describe the study methods as well as your most significant findings.

Dr Hatef: The main aim of the study was to assess the association of telehealth and in-person visits with outcomes of care during the COVID-19 pandemic. We used claims/insurance data on continuously enrolled members in private health plans of the Blue Cross and Blue Shield Association from July 1, 2019, to December 31, 2020. Outcomes of care were assessed 14 days after the initial encounters and included follow-up encounters of any kind, emergency department encounters, and hospitalizations after initial telehealth or in-person encounters. In this cohort study of 40 739 915 individuals (mean [Standard Deviation] age, 35.37 [18.77] years; 20 480 768 [50.3%] female), ambulatory encounters decreased by 1.0% and the number of in-person encounters per enrollee decreased by 17.0% from 2019 to 2020; however, as a proportion of all ambulatory encounters, telehealth encounters increased substantially from 0.6% (n = 236 220) to 14.1% (n = 5 743 718). 

While the overall encounters decreased from a mean of 2.46 encounters per person in 2019 to 2.46 in 2020; however, for behavioral health encounters, the per person encounters increased from 0.32 in 2019 to 0.36 in 2020.

Members with an initial telehealth encounter for a new acute condition had 44% higher rates of all follow-ups combined and 11% higher rates for an emergency department encounter. Members with an initial telehealth encounter for a new chronic condition had 6% lower rates of all follow-ups combined and 6% lower rates for in-patient admissions.

Mendoza, PCN: The cohort studied was commercially insured; how do you anticipate the results might have changed if that were not the case? Any plans to study non-insured patients in a similar manner? 

Dr Hatef: We did not include Medicare, Medicaid, or uninsured patients. Thus, experiences among these special needs patients could be different from those we documented in this study.

Elham Hatef, MD, earned her medical degree from Tehran University of Medical Sciences, in Tehran, Iran, and her Master in Public Health from Johns Hopkins Bloomberg School of Public Health (JHBSPH). Dr. Hatef completed a preliminary year in Internal Medicine at Yale-affiliated Griffin Hospital in Connecticut and the Preventive Medicine Residency and Chief Residency at JHBSPH. She then completed the Clinical Informatics Practice Pathway at JHBSPH. Dr. Hatef is board certified in Preventive Medicine-Public Health and Clinical Informatics.

As a preventive medicine-public health physician and clinical informatician, Dr Hatef focuses on population health, social and behavioral determinants of health, and health disparities using health IT and informatics. She is involved in several projects in this area; at the Johns Hopkins Center for Population Health IT (CPHIT) she led the development of population health framework and measurements for Maryland, a collaboration with Maryland Health Information Exchange (a.k.a, CRISP: Chesapeake Regional Information System for our Patients) supported through Maryland State Improvement Model and Centers for Medicare and Medicaid Services. She also led the project to evaluate the health outcomes such as hospitalization rate at the primary care level at the Veterans Health Administration while taking into account social and behavioral risk factors of veterans. Also, in collaboration with other faculty across Johns Hopkins University, she works on new methods of data mining and natural language processing to address social and behavioral determinants of health by using structured and unstructured data in electronic health records.