Annual telehealth visits among the commercially insured increased by 52% annually from 2005 to 2014 and 261% from 2015 to 2017, according to a new study published in JAMA on Tuesday. Visits increased from just 206 in 2005 to roughly 202,300 in 2017, most likely driven by increased payer coverage for direct-to-consumer telemedicine, the report says.
Overall, from 2005 to 2017, there were about 383,500 telemedicine sessions between nearly 217,900 (mostly female and urban-living) patients. Primary care telemedicine visits grew 36% annually before 2016 and then increased exponentially to about 126,400 visits in 2017. Use of telehealth services for mental health grew much more steadily, by almost 60% annually to about 57,000 visits in 2017.
The study, which attempts to address the lack of knowledge about telemedicine adoption nationwide, analyzed de-identified data from more than 200 million privately insured and Medicare Advantage enrollees in research group OptumLabs' database.
Telemedicine has been heralded by some as a balm to America's health disparities, a tool to improve access to specialty care (especially in traditionally underserved areas such as the rural U.S., where roughly 20% of the nation's population lives.)
Advocates cite the cost savings for telehealth initiatives as well. A 2017 report from the Rural Broadband Association found that such services were associated with an annual cost savings of $20,841 per U.S. hospital on average. By some estimates, telemedicine (including remote patient monitoring) could knock $4.3 billion off the country's yearly healthcare bill.
To facilitate adoption, 34 states and the District of Columbia have passed parity laws to date. These laws require payers to reimburse in-person health services and telehealth visits at similar rates, and can help incentivize providers to implement virtual options.
The JAMA study found that patients implementing telehealth services were on average 38.3 years old. It showed that 63% were female and 83.3% lived in urban areas, suggesting the practice may not yet be the savior of rural healthcare deficits that some proponents think it is.
Researchers slotted the information into three telemedicine visit categories: telemental health (mental health diagnoses and clinicians), primary care telemedicine (any non-telemental health visit with clinicians) and a catch-all category of all other specialist visits, examining trends against state parity laws and county-level physician supply.
Telehealth mental health services were more popular in counties with a dearth of psychiatrists, the report found, and in states with more equivalent reimbursement between in-person health services and telehealth.
However, the study did not find growth of primary care telemedicine to be associated with primary care physician availability, suggesting consumers are prioritizing convenience when they turn to telehealth services instead of making up for lack of doctors in their area.
Despite the growth from 2005 to 2017, telemedicine use is still relatively uncommon today. Only half of U.S. hospitals offer some kind of telemedicine service, according to the American Telemedicine Association.
A 2017 survey found that 30% of healthcare executives said telehealth was a high priority in their organization. Industry rigor on the practice has made the area relatively lucrative — the North American telehealth market is expected to reach $16.8 billion by 2020.
Challenges to widespread telehealth adoption remain. Telemedicine success varies depending on where and how it's used, according to the Agency for Healthcare Research and Quality. Determining telehealth's ROI is elusive in most cases, and concerns about overpayment for telehealth reimbursement persist.