- Telehealth use in the U.S. reached a pandemic low in October, surpassing a previous nadir in July, according to new data from nonprofit Fair Health.
- Following a long period of decline in 2021 bolstered by two months of growth in August and September, telehealth utilization dropped almost 7% from September to October, decreasing from 4.4% of all medical claim lines to 4.1%.
- The decrease was seen in all U.S. regions except the Northeast, which was particularly slammed with COVID-19 cases and rising hospital admissions during the fall and winter months.
Telehealth use appears linked to COVID-19 incidence in an area, rising and falling as cases do geographically. People seem more likely to avoid potential in-office transmission of the virus when coronavirus cases are high, electing instead to receive needed care through virtual means, data suggests.
After skyrocketing in 2020 to a historic peak in April, telehealth use began trending down starting in May that year, before ticking back up starting in October as colder weather and the holiday season caused more people to congregate indoors, resulting in more COVID-19 cases.
Use of virtual care started falling once again after January 2021, as the rising availability of vaccines and growing immunity in the U.S. population dampened the coronavirus' spread. Telehealth use reached a two-year low in July. But the rise of the more-infectious delta variant, coupled with persistent vaccine hesitancy among some populations (along with pandemic fatigue), contributed to fresh outbreaks and an upswing in virtual care. Telehealth use began climbing once again in August and September, by about 2% nationally each month, according to Fair.
But 2021 broke with the previous year's pattern of utilization in October. That month, telehealth use fell once again, making up only 4.1% of all medical claims in October — a new two-year low.
The Northeast bucked that trend, with the region's telehealth use remaining stable at 4.8% of medical claim lines. The biggest drop occurred in the South, which saw telehealth utilization plummet 11.4% from September to October.
In October, mental health conditions remained the top telehealth diagnosis nationally and in every U.S. region, and actually increased by 1.5% as a percentage of all telehealth claim lines. Similarly, an hour-long psychotherapy session increased as a share of all telehealth claim lines by about 1%, while remaining the top-ranking procedure code.
The pandemic has seriously exacerbated conditions like depression and anxiety, which climbed globally by more than 25% in 2020, according to a study published in the Lancet.
Experts peg mental health as a major clinical growth area for virtual care, as telemental visits have remained relatively strong even as virtual care usage drops off. Demand for digitally delivered mental healthcare is expected to continue even after the pandemic due to the pervasive lack of the specialty providers across the U.S., especially in rural areas, and the high price tag of therapy and other treatment.
That's resulted in a slew of investments in mental and behavioral services from telehealth vendors looking to capitalize on the demand.
Though the pandemic is a major driver of virtual care use, fewer and fewer people appear to be using virtual care to diagnose and treat COVID-19 itself, Fair found.
In October, COVID-19 dropped out of the top five telehealth diagnoses in the Midwest, the only region where it ranked in the top five in September. COVID-19 as of October was not in the top five telehealth diagnoses nationally or in any region.
It was replaced in the Midwest by substance use disorders. That region joined the Northeast in having that condition among its top five telehealth diagnoses.
COVID-19 pressures have also worsened substance use in the U.S., with overdoses skyrocketing during the pandemic, according to the Centers for Disease Control and Prevention. Fair's data continues to show more people are turning to telehealth for treatment, though experts say access remains an issue as regulations around telehealth for such services are patchy across different states.
Fair has used its database of over 34 billion private claims records to analyze the monthly evolution of telehealth since last May.
Investors are tracking utilization closely as they make bets on the future of an industry stoked by COVID-19, but that could wane as the pandemic does.
According to one analysis across all payers published in December, telehealth use declined by an average of 40% a month in 2021 compared to 2020. And despite its meteoric growth in 2020, telehealth use for traditional medical services remains nominal, raising some concerns about applicability for a broad range of services.
But many patients, providers and telehealth companies continue to lobby Washington for expanded telehealth access after the COVID-19 national health emergency is over. Legislators continue to mull how many pandemic-era flexibilities should remain in the long term, though there's bipartisan support for greater access on the Hill.