Studies Find Telemedicine Has Not Increased Costs and Serves Wide Range of Chronic Conditions
UCLA-led research finds telemedicine has not significantly increased healthcare visits or costs across all payer types from 2019-2023, published in JAMA Network Open. A separate study of Medicare patients reveals nearly half of telehealth visits are for non-mental health conditions, particularly chronic diseases like diabetes and high blood pressure. Both findings address questions about telehealth's role and impact since the COVID-19 pandemic.
New research indicates that telemedicine expansion since the COVID-19 pandemic has not significantly increased healthcare visits or costs, while a separate study reveals that nearly half of telehealth visits are now for non-mental health conditions, particularly chronic diseases like diabetes and high blood pressure.
A UCLA-led study published in JAMA Network Open analyzed multi-payer medical claims data from more than 3 million US adults continuously enrolled in Medicare fee-for-service, Medicare Advantage, dual-eligible Medicaid, or commercial insurance from January 1, 2019 through December 31, 2023. Overall, telemedicine visits fell 2.4% and spending dropped 0.5%, but these changes were not statistically significant, meaning researchers cannot rule out that the observed changes could simply be due to chance.
The findings could ease concerns among lawmakers that the telemedicine expansion during the pandemic would result in large utilization and spending increases. With the declaration of the COVID pandemic in 2020, the Centers for Medicare & Medicaid Services changed key policies regarding telemedicine flexibility, including payment parity with in-person visits, waiving geographic restrictions, and eliminating out-of-pocket cost sharing. Those CMS flexibilities are due to expire in 2027.
"Our findings suggest neither prediction came true on a national scale," said the study's lead author. "As telemedicine use grew, visits and spending in heavy users tracked closely with patterns in lighter users. That is reassuring for anyone worried about ballooning costs, but more sobering for anyone hoping telemedicine would close longstanding gaps in access. At least so far, it looks more like a substitute for in-person care than a true expansion of it."
The researchers did not find any significant changes across subgroups examined. For example, urban populations had 4.4% fewer visits and 2.3% lower spending, while there were 3.4% more visits and 3.8% higher spending in rural areas, but none of these changes were statistically significant.
A separate study of Medicare patients published in Annals of Internal Medicine found that nearly half of telehealth visits are for non-mental health conditions. The researchers examined health care visit data from a nationally representative sample of nearly 15,000 Medicare users during 2021 to 2023. Nearly half of mental health appointments were performed remotely, amounting to 31 million annual visits, but there were almost as many telehealth appointments for non-mental health conditions: 29 million annually.
The vast majority of these visits were for common health conditions like diabetes and high blood pressure, for which the sheer number of medical visits outweighs the relatively small fraction performed virtually. "We were surprised at the number of non-mental health conditions, like high blood pressure or diabetes, that were commonly addressed through telehealth," said the study's first author.
The data suggests that people who are most medically vulnerable are more likely to use telehealth. Telehealth users are more likely to report limitations in activities of daily living, like bathing and getting dressed, and are more likely to report worse health overall. Telehealth may be especially useful for people with more medical challenges, helping to alleviate barriers to care that these populations might disproportionately face.
The UCLA study also found that the results "crossed the null," meaning the changes observed were not statistically significant over the time period covered. While the confidence intervals could not rule out small changes in either direction, they did rule out large ones, indicating that any true effect on overall visits or spending was modest at most. The study's senior author noted that the analysis runs only through late 2023, when telemedicine use was still settling into a new equilibrium, and much more work is needed to understand telemedicine's longer-term effects on quality of care, health outcomes, and spending.