Study: Telehealth visits remain popular even after initial COVID surge
Over the course of 2020, patients went from seeing their doctors primarily on a Zoom screen at the onset of the COVID-19 pandemic, to returning to in-person visits for most of their care.
However, preliminary results of a state Health Policy Commission study show there are still areas where telehealth remains an important piece of the patchwork of health care in the state.
The Massachusetts Legislature in an early 2021 law charged the Health Policy Commission with studying the utilization of telehealth and its effect on total spending since the beginning of the pandemic, and with recommending possible policy considerations.
The commission's Market Oversight and Transparency Committee plans to present a finalized version of the study to the Legislature when it resumes formal sessions early next year.
According to the preliminary results reported at a committee meeting Wednesday, telehealth accounted for a third of all commercial ambulatory visits in 2020, reaching a record-high of 66 percent in April 2020 and leveling out around 32 percent for the last five months of the yea.
Mental health care made up almost two-thirds of all those visits, averaging 63.2 percent of telehealth appointments in 2020. In contrast, the clinical area with the second highest percentage of telehealth visits, musculoskeletal system care, accounted for only 4 percent of the total virtual visits.
"Patients really like telehealth, especially for mental health conditions," said commission research associate Yue Huang. "They feel it is really analogous to in-person visits."
As the pandemic hit, Gov. Charlie Baker signed an executive order on March 10, 2020 expanding access to telehealth services. A key part of that order was a provision that insurance carriers ensure rates of payment to in-network providers are not lower than rates of payment for traditional, in-person visits.
In January 2021 Baker and the Legislature shored up this executive order with a telehealth law that mandates permanent payment parity for telemental health services and establishes parity for primary care and chronic care management for two years -- expiring this January.
The committee's study shows telehealth and in-person office psychotherapy services were paid at roughly the same rates in 2020, consistent with the payment parity mandate.
However, there is a financial difference between in-person and telehealth visits where cost-sharing came into play. Insurers largely waived cost-sharing fees for patients to visit with a therapist remotely in 2020, but continued those costs for in-person visits, the study found.
The committee also found that people who live in urban areas were more likely to use telehealth, as well as older individuals and people with higher health risks.
One area where the study may show results contrary to preconceived notions, Huang said, is in the similarities in telehealth usage between people of different income levels.
"People tend to assume people living in higher income areas might use telehealth more," she said. "In the raw results, where we looked at the percentage of members with telehealth use by community income quintile, the percentages were really similar. They are within one percentage point."
After adjusting for some outside factors, Huang said, those living in higher income communities actually used telehealth slightly less than those in lower income brackets.
Geographically, there was a higher percentage of telehealth use in the Metro Boston area, the Pioneer Valley and on Cape Cod. Outside of the Pioneer Valley, there was a much lower percentage of virtual visits in the central and western parts of the state.
In addition to utilization of this tool, the Legislature asked the commission to analyze effects of telehealth on total spending.
They reported telehealth use did not appear to increase total utilization or spending, and that cost-sharing for telehealth did not appear to affect demand.
"The study suggests that these were substantive visits, not additive," said commission executive director David Seltz. "And on the spending level, it didn't appear to increase spending nor did it appear to decrease spending if you were in a community with higher telehealth use."
Seltz added that the sharp increase in virtual mental health visits, however, indicates telehealth allowed greater utilization and greater spending on mental health conditions.
Market Oversight and Transparency Committee Chair David Cutler added that mental health care was the "key" and the "single biggest change" to moving toward telehealth.
"That's a very good thing, because it was clearly providing needed access," Seltz said.
The committee will continue its research and analysis before making its presentation to the Legislature in January.