Utilizing its dataset of medical claims, representing care received by more than 2.2 million people, the Midwest Health Initiative (MHI) has evaluated COVID-19 related utilization trends among Missouri’s commercially insured adults aged 18-64 years from March 2020, when COVID-19 arrived in Missouri, through the first quarter of 2021. MHI intends this analysis to compliment the work of others; this brief compares trends in utilization of telemedicine and in-office care.
All Telehealth: The ability to rapidly transition from in-person to virtual visits allows for continuity of care and chronic disease management during infectious outbreaks and other major disasters that obstruct traditional care models. The Centers for Disease Control and Prevention (CDC) reported a 154% increase in telehealth visits during the last week of March 2020 as compared to the same time period the year prior; they further speculate that this is likely attributable to pandemic-related telehealth policy changes and public health guidance.1 The Midwest Health Initiative (MHI) found that telehealth visits in the first four months of 2020 were 530% greater than all of 2019. Telehealth— defined as calls or video visits covered under the medical benefit— was not widely used until the pandemic prompted stay-at-home orders and social distancing, after which its utilization skyrocketed.
Telehealth visits were 530% higher in the first four months of 2020 than for all of 2019 combined.
The CDC also reported that, nationally, telehealth utilization increased among all age groups.1 MHI found the same trend in Missouri, with those aged 40-64 years comprising the largest proportion of users. While the younger population might be assumed to use technology more frequently, they likely have fewer reasons to seek health care services relative to those aged 40-64 years.
In 2020, Missouri’s commercially insured aged 40-64 years used 8.3% more telehealth services than those 18-39 years of age.
Primary Care: One national study found that primary care visits decreased overall in the first quarter of 2020, but telehealth utilization experienced a surge during that same period.2 MHI data showed a parallel trend, with in-office primary care decreasing by 28.8% and telehealth primary care increasing by over 300% from March to April of 2020. Here, primary care telehealth is operationalized as calls or video visits with a patient’s regular primary care provider, not a stand-alone service.
Telehealth primary care visits increased from just 8 visits per 1,000 persons in March of 2020 to 37 visits per 1,000 persons in April of 2020, nearly a 360% increase.
Specialty Visits: One study, published in the journal Health Affairs, found that, before COVID-19 came to the U.S., fewer than 2% of clinicians surveyed used telemedicine.3 MHI’s data showed minimal specialty telehealth utilization pre-pandemic, with a swift adoption of visits from February 2020 to April 2020, increasing by nearly 10x the previous rate.
Mental Health: Both in-person and virtual mental health services increased dramatically in the first four months of 2020 and remained elevated throughout the first year of COVID-19. On average, there were 86 mental health visits per 1,000 persons, both in person and online in the first four months of 2020. Mental health utilization has remained elevated since the onset of the pandemic.
Dermatology: A new study showed telemedicine services can be expanded quickly and successfully to patients with skin conditions; three pilot sites were able to rapidly transition from in-person to telehealth visits at the onset of the pandemic, increasing their virtual practice by 191% in just two weeks.4 In Missouri, dermatology telehealth utilization was almost nonexistent before the pandemic; once COVID-19 arrived in the state, dermatology telehealth visits increased by 200 times. Since then, dermatology telehealth utilization has stabilized at levels over 10X pre-pandemic rates.
Eric Armbrecht, PhD, Professor in the Department of Health and Clinical Outcomes Research at Saint Louis University, stated “In a telehealth research project with SLUCare Dermatology colleagues, we learned that 63% of patients with commercial insurance would choose a virtual appointment again after the pandemic; and 81% of Medicaid patients said they would. Telehealth is a way to expand access to specialty care, even for lower-income members in our community.”
Stay tuned for the next installment of The Impact of COVID-19: Trends in Missouri’s Commercial Health Care Market chart book series, which will highlight trends in Facility Utilization and Acute Conditions. For more information about the Midwest Health Initiative and its work please visit our website.
Koonin LM, Hoots B, Tsang CA, et al. Trends in the use of telehealth during the emergence of the COVID-19 pandemic - United States, January-March 2020. MMWR Morb Mortal Wkly Rep. 2020;69(43):1595-1599. doi:10.15585/mmwr.mm6943a3
Alexander GC, Tajanlangit M, Heyward J, Mansour O, Qato DM, Stafford RS. Use and content of primary care office-based vs telemedicine care visits during the COVID-19 pandemic in the US. JAMA Netw Open. 2020;3(10):e2021476. doi:10.1001/jamanetworkopen.2020.21476
Patel SY, Mehrotra A, Huskamp HA, Uscher-Pines L, Ganguli I, Barnett ML. Variation in telemedicine use and outpatient care during the COVID-19 pandemic in the United States: Study examines variation in total US outpatient visits and telemedicine use across patient demographics, specialties, and conditions during the COVID-19 pandemic. Health Aff (Millwood). 2021;40(2):349-358. doi:10.1377/hlthaff.2020.01786
Perkins S, Cohen JM, Nelson CA, Bunick CG. Teledermatology in the era of COVID-19: Experience of an academic department of dermatology. J Am Acad Dermatol. 2020;83(1):e43-e44. doi:10.1016/j.jaad.2020.04.048
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