The coronavirus pandemic has changed many aspects of the American health care system, but nothing changed quite as drastically as the rise of telemedicine.
While virtual care existed before COVID-19, the practice boomed after state-mandated, stay-at-home orders and have since remained strong.
Prior to the pandemic, Blue Cross Blue Shield of Massachusetts received about 200 telehealth claims per day. That number reached up to 40,0000 claims per day from April to May 2020, and the insurer is still receiving about 30,000 claims per day almost a year later, according to spokesperson Amy McHugh.
Athenahealth, a health tech company, released an interactive dashboard that delivered insights on telehealth trends from 18.4 million virtual appointments by 60,000 providers.
“The pandemic has necessitated a new era in medicine in which telehealth appointments are a core aspect of the patient-provider relationship,” said Jessica Sweeney-Platt, the company’s vice president of research and editorial strategy.
Here are some telemedicine trends the company and other health experts have found:
Mental health appointments dominate virtual care
Telemedicine had the biggest impact on mental health visits with approximately 33{b5d304c96e94113bdfc523ff4218a1efff4746200bdb9eeb3214a56a1302f2e4} of appointments held virtually, according to athenahealth’s dashboard data.
McHugh said mental health appointments made up about 53{b5d304c96e94113bdfc523ff4218a1efff4746200bdb9eeb3214a56a1302f2e4} of the 7.5 million telehealth claims processed by Blue Cross Blue Shield of Massachusetts since March 2020.
“Telehealth lends itself to mental health fairly easily because you’re essentially just talking to somebody, so that you can do from pretty much anywhere,” said. Dr. Georgia Gaveras, chief psychiatrist and co-founder of Talkiatry, a technology-driven psychiatric care provider.
Consequences of the COVID-19 pandemic – such as job insecurity or the loss of a loved one – has had a significant impact on Americans’ mental health with anxiety and depression becoming the most common issues, experts say.
A survey conducted by the Centers for Disease Control and Prevention in June 2020 found more than 40{b5d304c96e94113bdfc523ff4218a1efff4746200bdb9eeb3214a56a1302f2e4} of respondents reported an adverse mental or behavioral health condition, and 11{b5d304c96e94113bdfc523ff4218a1efff4746200bdb9eeb3214a56a1302f2e4} reported having seriously considered suicide in the 30 days prior.
“The pandemic and telehealth have made seeking out mental health treatment a non-negotiable for a lot of people,” Gaveras said.
Apart from the growing need for mental health treatment, she said telehealth has also made it easier to seek care for those who may have needed it before the pandemic. Many of her patients schedule appointments in the middle of the work or school day.
The flexibility of telehealth has also led to a level of discretion, Gaveras said, as some patients don’t want to be seen entering a psychiatrists office or leaving work for regular visits.
“Telehealth is really getting people out there and seeking help for mental health more,” she said. “The more people seek out mental health treatment, the less stigmatized it is.”
Primary care also drives telehealth appointments
After mental health, primary care was the second largest percentage of telehealth appointments with 17{b5d304c96e94113bdfc523ff4218a1efff4746200bdb9eeb3214a56a1302f2e4} of primary care visits being held virtually, according to the athenahealth dashboard.
“A lot of primary care is talking,” said Dr. Katherine Dallow, vice president of clinical programs and strategy at Blue Cross Blue Shield of Massachusetts. “It’s meeting them where they are, hearing their concerns.”
Most of the physical aspects of a primary care visit – such as measuring weight and blood pressure – can be done at home with inexpensive equipment. Other physical examinations only require a camera and can be easily diagnosed virtually.
The top reasons for telehealth claims for primary care were general exams, hypertension, lower back pain, asthma, abdominal or pelvic pain, and anxiety or insomnia, according to data from Blue Cross Blue Shield of Massachusetts.
Of the 7.5 million telehealth claims during the COVID-19 pandemic, 60{b5d304c96e94113bdfc523ff4218a1efff4746200bdb9eeb3214a56a1302f2e4} were virtual and 40{b5d304c96e94113bdfc523ff4218a1efff4746200bdb9eeb3214a56a1302f2e4} were by phone.
Dallow said telehealth has also forced doctors to be more conservative about ordering lab work or imaging, leading to a decrease in unnecessary testing.
“When you have a telephonic visit, you’re going to think really long and hard as to whether a person must go to a location to get labs and radiology” instead of staying safe at home, she said.
Same-day appointments and shorter visits
Telehealth appointments are almost two times as likely to be scheduled for the same day compared to in-person visits, according to athenahealth data. They were also more likely to occur after-hours or on the weekends.
The flexibility of telehealth has allowed doctors to organize their workday to cater to both in-person and virtual appointments, Dallow said. The means less people in the office at one time, Dallow added, creating more opportunities for social distancing.
Telehealth appointments are also more likely to be under 15 minutes long compared to in-person visits. While some patients may be concerned that this decreases the quality of care, doctors argue it’s actually a sign of efficiency which can help increase the quality of care.
“I probably spend somewhere between 2 to 5 minutes per patient moving from one room to another or pausing to document or checking something on their file or handing something off,” Dallow said. “There are built-in inefficiencies that isn’t time spending with the person… but some of those inefficiencies are taken care of by the fact that everything is electronic.”
Is telehealth here to stay?
It’s unlikely the U.S. will revert to its conservative use of telemedicine from before the coronavirus pandemic, health experts say.
“A lot of people had wanted to bridge the gap between technology and provision of health care long before the pandemic,” Dallow said. “What happened with COVID, for better or worse, was the entire industry was freed up from all the regulatory issues that had been a barrier to people accessing virtual care.”
But will those barriers return after the pandemic?
Sweeney-Platt from athenahealth said the biggest unanswered question in telehealth is the future of reimbursement status.
“There’s a lot of conversation on the policy front and payer community about the temporary changes that were made to reimbursement policies during the COVID pandemic,” she said. “Should they be made permanent? That’s the biggest area of uncertainty for providers in particular.”
Blue Cross Blue Shield of Massachusetts said it’ll continue to support and cover telehealth. However, insurance companies have less control of other barriers such as increasing accessibility throughout the country and cracking down on fraud.
“This is an industry issue,” Dallow said. “We all need to meet in the middle on how to make (telehealth) the safest, most efficient, most affordable and most accessible form of receiving health care when possible.”
Follow Adrianna Rodriguez on Twitter: @AdriannaUSAT.
Health and patient safety coverage at USA TODAY is made possible in part by a grant from the Masimo Foundation for Ethics, Innovation and Competition in Healthcare. The Masimo Foundation does not provide editorial input.
