ABSTRACT
Objectives: In response to the disruption of in-person healthcare visits during the Covid-19 pandemic in the US, public and private payers expanded their coverage and reimbursement for telehealth (TH) services starting March 2020. To account for this new driver of healthcare resource utilization, we created a standardized definition of TH utilization from administrative claims to improve research quality. We used this definition to investigate trends in TH utilization in a large US commercially insured/Medicare Advantage/Supplement population. Methods: Administrative claims from 1/1/2006 to 8/31/2021 from the HealthCore Integrated Research Database® were used to identify TH claims. We defined TH based on outpatient claims containing at least one of the following TH designations (not mutually exclusive): place of service codes, CPT codes, CPT modifiers, and certain Tax IDs from known telehealth providers. Coding patterns and TH utilization over time were evaluated. All analyses were descriptive. Results: Over the 15-year period, 57% of TH claims occurred in 2020 and an additional 39% in 2021 (through August). In 2019/2020/2021, the share of outpatient claims designated as TH was 0.1%/4.8%/4.4%. Utilization was slightly higher among commercially-insured compared to Medicare Advantage/Supplement patients (5.0% vs. 3.9% in 2020). Most TH use was identified via CPT modifier codes (80%), followed by place of service codes (53%). Evaluation & management visits and specialist physician services each accounted for approximately 45% of all TH claims. Approximately 8% of TH claims were for audio-only visits based on submitted codes. Conclusions: We created a standardized algorithm to identify TH using claims data. Consistent with prior reports, TH utilization increased substantially following onset of the Covid-19 pandemic in conjunction with increased coverage and reimbursement for the service. Incorporation of TH utilization via this algorithm is an essential tool for all health economic and outcomes research studies evaluating time periods from 2020 and beyond.
ABSTRACT
India has been on a steady march to address malnutrition in the last decade. The nutrition community has worked on building consensus on key actions, implementation platforms were put in place and financing for nutrition slowly increased. Under the strong leadership of the Prime Minister, a revolutionary program to address malnutrition was launched in 2018. As actions under the mission accelerated, the COVID-19 pandemic arrived in early 2020. Affecting health systems, food systems, nutrition programs, social safety nets, and the economy, the pandemic has the potential to exacerbate the challenge of malnutrition in multiple ways. India can mitigate some of the possible ways in which COVID-19 will affect malnutrition but will require strong leadership and continued commitment, adaptation of the national nutrition mission, strengthening of the social safety net and innovative evidence-based data to take informed decisions, implement them and ensure feedback to take necessary corrective action. In this article, we outline some challenges and key areas for action. We conclude that India's nutrition journey is too important to be derailed by a crisis like COVID-19. This is a clarion call for the nutrition community in India to rally strongly to support continued attention to malnutrition in all its forms, to generate relevant evidence, and to support and engage all of society to urgently and adequately address malnutrition in the context of the COVID-19 pandemic. We have come too far to turn back now. © 2021 Wolters Kluwer Medknow Publications. All rights reserved.