Consumers expect expanded telehealth to remain post-COVID-19, survey finds

• COVID-19 made telehealth “an indispensable part of the healthcare system,” according to a public survey.
• Telehealth visits have fallen off their April peaks amid concerns that payments will decline.
• Hospitals and health plans are pushing CMS and Congress for policy changes to sustain long-term use of telehealth.

Large majorities of healthcare consumers support the expansion of telehealth options during the COIVD-19 pandemic and want those options to remain after the disease passes.

Telehealth-related results from a national survey of 1,945 consumers conducted by The Harris Poll and commissioned by Change Healthcare included:

• 81% believe COVID-19 will fundamentally change healthcare delivery
• 81% believe the pandemic will speed digital adoption
• 89% say COVID-19 made telehealth “an indispensable part of the healthcare system”
• 65% plan to use telehealth more after the pandemic
• 78% say COVID-19 showed the extent to which more telehealth options are needed

The public support for telehealth followed a surge in its use since the start of the pandemic in the spring, when the federal government announced physical-distancing guidelines and governors and mayors asked, and sometimes required, residents to stay at home to stop the spread of COVID-19.

Public and private health plans encouraged the switch to telehealth by lowering or eliminating patient out-of-pocket costs and increasing provider payments to the level of in-person care. Additionally, state and federal regulators lightened restrictions to make such services easier to access.

The results of those changes were significant. Before the pandemic, 15% of consumers with employer-based insurance had used video telehealth, according to unpublished surveys by PwC. During the pandemic, 9 million used it for the first time.

Providers also have embraced telehealth, with many reporting vast increases in the number of visits provided through phone and video.

For instance, tele-visits at Yale New Haven Health System increased from less than 2% of patient encounters before the pandemic to 30% by mid-June, said Christopher O’Connor, executive vice president and COO.

“We hope it does not decline,” O’Connor said.

Additionally, many hospitals and health systems have invested significantly in improving telehealth. For instance, health systems accounted for 34% of all corporate venture deals for digital health in the first half of 2020, according to a recent report by Rock Health.

Will the telehealth push continue?

However, data indicates that as some parts of the country moved to reopen and healthcare providers resumed full operations in the early summer, telehealth use began to decline.

For instance, a June 25 analysis by the Commonwealth Fund found the share of telemedicine visits declined to 7% of visits after peaking at 14% in mid-April (the authors warned the share is likely an undercount). At the same time, in-person visits came back from a 69% decline in the first week of April to only an 18% decline by mid-June.

“Some of this is due to an increase in the number of in-person visits, but some of this is also due to increasing concerns on the part of providers about whether telehealth will persist, whether the significant investment required to perform telehealth is worth it and whether payment rates from payers will ultimately support the ongoing use of telehealth,” said Edward Jhu, a principal and consulting actuary for Milliman.

Some providers have warned that commercial health plans are starting to roll back payment expansions and other policies that encouraged the use of telehealth, according to published reports.

Telehealth policy changes sought

Providers and health plans have urged policy changes to sustain the use of telehealth.

At a July 9 meeting, Seema Verma, administrator of CMS, said the agency wants to maintain telehealth but that new authorizations are needed from Congress.

The Federation of American Hospitals wrote CMS a letter July 10 to urge both administrative steps and that the agency work with Congress to change temporary COVID-19 waivers to permanent Medicare policy.

The recommendations included:

• Establishing a “glide path” for phasing out COVID-19 waivers put into effect during the public health emergency
• Allowing treatment of hospital outpatients at home through remote technology
• Ensuring that payment for healthcare services provided remotely through technology reflects differences in cost structures among the entities that provide such services

Similarly, America’s Health Insurance Plans urged a series of policy changes that the group says would help sustain the use of telehealth. These included:

• Allowing more benefit design flexibility, including on provider payments
• Eliminating barriers to access, such as geography-based restrictions
• Allowing telehealth to count toward network adequacy requirements