Telehealth helped chronically ill during pandemic but their access to care worsened: CDC

• A survey found 32% of those with chronic disease used telehealth recently.
• The pandemic reduced access to care for 39% with chronic health conditions.
• Health systems have urged some chronically ill patients to return to in-person care after lockdowns lifted.

Although one-third of people with chronic health conditions were able to access telehealth in recent months, 43% said the pandemic had reduced their access to care, according to new federal survey data.

Thirty-two percent of people with at least one chronic health condition used telehealth during the pandemic, the Centers for Disease Control and Prevention (CDC) reported this week. The findings were based on surveys of a nationally representative sample of 6,800 respondents recruited by NORC in early June through early July.

Telehealth use for specific chronic health conditions included:

• 44% of those with diabetes
• 37% of those with asthma
• 33% of those with hypertension

However, access to care still suffered—especially for patients with chronic disease. Among all adults, 39% missed one or more types of care in the last two months due to the coronavirus pandemic, while 43% of chronically ill reported such obstacles.

Missed care reported by those with various conditions included:

• 47% with asthma
• 43% with diabetes
• 43% of those with hypertension

Katherine Irimata, PhD, a statistician for the National Center for Health Statistics, said in a webcast that the worse access outcomes for those with chronic health conditions may stem partly from the greater frequency with which they seek care. The ongoing survey may delve into understanding such differences, she said.

However, the CDC has no plans to ask in future surveys whether the reduced access was linked at all to self-described worsening of health conditions.

Healthcare providers and researchers have warned that the pandemic and policy responses to it could produce widespread disruptions in care, especially for those with chronic disease that require ongoing management to control the conditions.

Although some research has found sharp reductions during the pandemic in cancer screening and vaccinations, extensive evidence on adverse outcomes from untreated conditions has not yet emerged, providers said.

Telehealth changes

Definitive Healthcare, a data analytics firm, has found a 4,000% increase in telehealth claims when comparing January through April 2019, compared with the same period in 2020. Additionally, it identified 41 million telehealth claims filed from April to July.

“We have seen telehealth increase over the years, but it has certainly been pushed out of necessity due to COVID-19,” Matthew Valley, data analyst for Definitive Healthcare, said in an interview.

Recent data indicated 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.

However, Valley expects healthcare organizations will maintain the use of telehealth, especially for chronic health conditions, and increase commensurate investments in the technology.

What providers are seeing

During the public health emergency, CMS has allowed telehealth payment for 135 additional services such as emergency department visits, initial inpatient and nursing facility visits and discharge-day management services, according to the agency.

In addition to a large expansion of telehealth in Medicare, commercial health plans generally took similar steps, said Robert Fields, MD, senior vice president and CMO of population health at Mount Sinai Health System in New York City.

Those health plans have implemented telemedicine coding changes “to try to support the kind of work that systems are doing in response to COVID to improve access and still manage chronic conditions in a rather bizarre environment,” Fields said in an interview.

Like most hospitals and health systems, Trinity Health has used telehealth during the pandemic and its associated lockdowns to try continue treating many patients unable to seek in-person care, said Harpreet Cheema, vice president of product and development for the Michigan-based health system.

For instance, patients concerned about contracting COVID-19 have used virtual care to avoid emergency department use and to obtain needed prescriptions, he said in an interview.

Going forward, Trinity Health is urging private and government health plans to maintain eligibility and payments for telehealth as an option for patient who want to use it.

Since states began to lift broad lockdown orders, Trinity Health patients have begun to move back toward in-person care, said Emily Brower, senior vice president of clinical integration and physician services.

“People did return to care, which was a good thing, because we were very concerned about the delay of necessary care,” Brower said. “Now, people are in a place in most of our networks where now they have the choice” between in-person and telehealth care.

Long term, she expects telehealth services at the health system will remain “at a much greater level than it was prior to COVID-19.”