New Telehealth Users Expected to Keep Accessing Virtual Care

Telemedicine has become an alternative to emergency room visits

Stephen Miller, CEBS By Stephen Miller, CEBS August 11, 2021

Access to telehealth kept people out of hospital emergency rooms, new research shows. That's likely to result in lower claims costs for employers.

About 1 in 7 people (14 percent) who used telehealth said they would have sought care in an emergency department or urgent care facility if telehealth had not been available, and more than half of those people had their primary health issue resolved using telehealth, based on responses from 1,776 adults interviewed June 28 to July 18, 2021.

The survey, conducted by the Bipartisan Policy Center (BPC) and Social Sciences Research Solutions (SSRS), showed that:

  • One-third of respondents reported having a telehealth visit for themselves or a dependent last year.
  • 8 in 10 adults said their primary health issue was resolved during their telehealth visit.
  • The most common purpose for a telehealth visit was a preventive service, prescription refill or routine visit for a chronic illness.
  • Rural residents said they were more likely to use telehealth for surgical consults than people living in non-rural areas.

The survey also found that more than 9 in 10 adults were satisfied with the quality of their visit and were equally satisfied with both audio and video telehealth visits. Older adults were more likely to use audio-only, telephone services, however.

"New telehealth flexibilities have allowed millions of Americans to access health care from home, and as our survey shows, telehealth has the potential to take non-emergency cases out of the emergency department," said Marilyn Serafini, BPC health project director.

No Going Back

According to an August issue brief from the nonprofit Employee Benefit Research Institute (EBRI), "Telemedicine visits spiked during March 2020, when states issued stay-at-home orders and health care providers suspended nearly all in-person outpatient services. While patients' use of telemedicine for visits decreased after April 2020 from their meteoric highs, there is evidence that telemedicine visits have remained persistently higher than their pre-pandemic trends."

The researchers also found that, based on a recent analysis of EBRI's Telemedicine Database of claims data for nearly 150,000 employees:

  • Telemedicine users tended to be older and disproportionately female relative to patients who do not use telemedicine.
  • The vast majority of telemedicine users had only one or two encounters with a health care provider via telemedicine, possibly indicating that telemedicine services were used to address acute needs or were used as a bridge for patients with chronic conditions.
  • Telemedicine was used more frequently for respiratory symptoms and mental health issues, while face-to-face visits were used more frequently for musculoskeletal and connective tissue problems.
  • Employees covered by an employer-sponsored plan were more likely to seek care via telemedicine than their spouses or dependents, "perhaps indicating that [they] were more comfortable seeking care for themselves via telemedicine, were more familiar with their employer's telemedicine offerings, or were better-informed at work about the cost benefits and availability of telemedicine services," said Jake Spiegel, EBRI research associate and author of the report.

"Telemedicine has long been touted as a convenient and cost-effective means for health care providers to deliver services to patients," Spiegel added. "However, the COVID-19 pandemic thrust telemedicine into the spotlight when many providers ceased most elective in-person services."

He added that "even after stay-at-home orders were lifted and health care providers resumed conducting in-person visits, telemedicine engagements remained above their pre-pandemic trend. This could be evidence of a transformational effect of the COVID pandemic regarding how Americans seek out and receive care."

Regulatory Issues Remain

During the COVID-19 public health emergency, Congress and the administration temporarily waived many restrictions for telehealth used by Medicare recipients. Many states also modified their requirements on telehealth providers, such as by waiving rules that restricted residents' insurance coverage of telehealth to in-state doctors, according to the Federation of State Medical Boards.

The Commonwealth Fund, which supports independent research on health care, reported that 22 states changed laws or policies regulating state-licensed insurers during the pandemic. These states took actions such as: restricting insurers from limiting telehealth coverage to visual virtual visits by requiring that they also cover audio-only services; waiving cost-sharing (or requiring cost-sharing no higher than identical in-person services); and requiring reimbursement parity between telemedicine and in-person services.

"As temporary orders and voluntary insurer efforts end, policymakers are considering how best to regulate telemedicine post-pandemic," according to the Commonwealth Fund's report.

That regulation has begun to happen. Arizona lawmakers, for example, passed legislation in May making the state's pandemic-related telehealth waivers permanent, including requiring insurers to cover audio-only visits and allowing out-of-state medical professionals to conduct telehealth visits with patients in the state, according to health industry news website Healthcare Dive. 

Meanwhile, "other states like New York, Minnesota, Florida and Alaska are among those that have pulled back emergency waivers" or let them expire, according to the website.

[Want to learn more? Join us at the SHRM Annual Conference & Expo 2021, taking place Sept. 9-12 in Las Vegas and virtually.]



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