State-Specific Variation in Medicare Telehealth Utilization During the COVID-19 Pandemic.

Introduction: A number of reports are available exploring how telehealth use grew during the COVID-19 pandemic and public health emergency. Some have reported variations in telehealth uptake by specialty, but few have explored growth in telehealth utilization by both specialty and state, arguably the most salient combination of regulatory domains. Methods: We extracted telehealth claims from Medicare public use data files in 2019 and 2020. We calculated utilization by state both as raw encounters and as encounters per 10,000 Medicare beneficiaries in each state. We categorized providers into four major groups (primary care, specialty care, nurse practitioners and physician assistants, and behavioral health) to further explore variations in uptake among these groups. We generated tables and maps to display the variations found. Results: Growth in raw telehealth encounter volume was dominated by large states. Growth in telehealth volume per 10,000 beneficiaries was dominated by states in the Northeast and showed four- to fivefold variation between the least and greatest. Growth by state and provider group varied by even wider margins, with some states showing large amounts of growth among some provider groups, but relatively little growth in others. No states showed relatively robust growth in telehealth across all provider groups. Discussion: Growth in telehealth during the public health emergency was generally robust, but varied considerably across states and provider types. Recognizing this variation is important, and further exploring potential sources of variation is an important task for future research.

Telehealth Utilization During the COVID-19 Pandemic: A Preliminary Selective Review.

Background: The COVID-19 pandemic reduced in-person visit volume and fueled a corresponding explosion in demand for telehealth services, resulting in the enactment of several temporary state and federal policies to allow greater flexibility in delivering telehealth services. This review examines patterns in telehealth utilization during the pandemic by synthesizing available findings from large-scale studies. Methods: To be included in this review, studies must be of original research, include data from 2020 or 2021, have a U.S. study population, and analyze telehealth encounter data across multiple payers and health systems. This review includes 10 studies that fully met the inclusion criteria and 29 studies that examined telehealth use during the pandemic, although not from multipayer, multihealth system data sets. All studies were identified using Ovid MEDLINE and Google Scholar. Results: At its peak, telehealth accounted for roughly 15-50% of visits across the various studied populations and data sets. The more telehealth was utilized, the smaller the decrease in overall visit volume. Audio visits tended to be used more often than video visits, and telehealth utilization varied across geographic regions and medical specialties. There were disparities in telehealth use by race, age, income, and other factors. Discussion: Most telehealth visits during the pandemic would not have been reimbursable without the telehealth policy changes that took place. The variability in telehealth utilization across geographic regions is likely attributed to state-level telehealth policies. Most studies examining disparities in telehealth utilization did not compare disparities from before and during the pandemic, and these disparities may be a characteristic of health care overall rather than of telehealth specifically.

The Impact of the Medicaid Expansion on Telemental Health Utilization in Four Midwestern States.

Introduction: Low-income populations experience many barriers to accessing affordable, high-quality mental health services. One promising approach to improving access to care may be utilizing telemedicine in combination with expanding state Medicaid programs to cover low-income childless adults. This combination has the potential to reduce the prevalence of untreated mental illness; improve low-income populations' health and well-being; and save individuals', health care centers', and federal and state governments' money. Materials and Methods: A secondary data analysis on state Medicaid claims data was performed to calculate the percent difference in telemental health claims from 2014 through 2017 between two Medicaid expansion and two nonexpansion states in the Midwest. The percent change in claims during this time period within each of the four states was also calculated. Lastly, the difference between Medicaid telemental health utilization and other types of Medicaid telemedicine utilization was examined. Results: The Medicaid expansion states (Iowa and Minnesota) had 54% more telemental health claims per 10,000 state population than nonexpansion states (Nebraska and Wisconsin) from 2014 through 2017. During this time period, Iowa, Minnesota, and Nebraska experienced 481%, 329%, and 12% increases in Medicaid telemental health claims, respectively, and Wisconsin experienced a 10% decrease. Discussion and Conclusions: Medicaid telemental health utilization has been increasing since 2014 in the two Medicaid expansion states, especially in Iowa, while utilization has remained relatively constant in the two Medicaid nonexpansion states. This has implications for informing Medicaid policies, particularly with regard to Medicaid expansion and telemedicine reimbursement.