The COVID-19 pandemic had a unique and potentially long-lasting impact on the United States healthcare system. One area in particular that saw a transformative shift in how and how frequently services were utilized was telehealth. Telehealth is defined as any health-related service delivered virtually, whether by phone, video, messaging, or remote monitoring. Before the COVID-19 pandemic, telehealth was most widely used in the form of non-emergency doctor visits and non-opioid prescriptions. Despite the relatively low cost and convenience, only about two-thirds of employers offered a telehealth benefit,¹ and telehealth services represented only about 1.5% of all healthcare services. Additionally, the population who used telehealth tended to skew towards a younger, more tech-savvy group². 

Then, beginning in early 2020, the United States declared a public health emergency, and telehealth utilization skyrocketed, increasing by more than 500% in the second and third quarters². The COVID-19 pandemic was the obvious catalyst for this change. More specifically, the increases were driven by:

• Social distancing: People intentionally steered clear of doctors’ offices and hospitals when possible to avoid exposure to COVID-19 since it was likelier for someone to be exposed in a healthcare setting than elsewhere.
• Government intervention: Because of the public health emergency, the federal government reduced telehealth restrictions and increased payment parity to encourage utilization.
• Convenience: Once telehealth started to gain some momentum, patients realized that they could get care virtually without sacrificing quality. For many, the convenience of not traveling or waiting in a waiting room outweighed the perceived benefits of physically being in the same room as a medical professional.

As social distancing restrictions were loosened and with the public health emergency officially ending in May 2023, a decrease in utilization after 2020 and 2021 was to be expected. In 2022, telehealth services were only about half of 2020 levels² (full 2023 data is not yet available, but preliminary 2023 utilization appears to be tracking closely to 2022). However, utilization remains well above pre-pandemic levels and should be expected to continue to stay that way in the future. Additionally, the percentage of employers offering telehealth benefits has increased to more than 90%³ (from 69% in 2019).

Increased telehealth utilization is generally an overall positive for health plans and the healthcare system. The convenience of telehealth care means reduced time and expense for the patient, both in terms of travel and while waiting for an appointment. Virtual care potentially reduces cost on the provider side as well – as there is less of a need for care to be delivered in a brick-and-mortar setting, costs associated with office upkeep, staffing, and travel should be reduced. Additionally, patients who live in more rural areas have the same or similar access to a healthcare provider as those living in urban areas, which increases health equity. 

However, it should be noted that equity concerns still exist – telehealth generally favors patients who are more tech-savvy and wealthier, and continuing to increase health equity should be a primary focus of telehealth in the future. Furthermore, regulations and payment policies will need to continue to be adapted as telehealth evolves and progresses to support long-term growth and sustainability. Finally, given how little utilization in telehealth there was prior to 2020, much is still unknown in terms of how to best optimize and increase efficiencies for virtual care. As more data is collected and released, further analysis will be required to ensure telehealth thrives in the future. 

The COVID-19 pandemic had an evident impact on telehealth utilization in the United States. While increased telehealth utilization is overall positive for the healthcare system, future changes will need to be considered to ensure equity and efficiency within the telehealth space. 

Sources

  ¹ The Kaiser Family Foundation Employer Health Benefits 2019 Annual Survey

  ² SOA Research: Digital Health: After the COVID Boom

  ³ The Kaiser Family Foundation Employer Health Benefits 2023 Annual Survey

This update is not intended to be exhaustive, nor should any discussion or opinion be construed as legal advice. Readers should contact legal counsel for legal advice. All rights reserved.