COVID-19 Healthcare Coalition: Telehealth Impact Study: Claims Data Analysis

The COVID-19 pandemic brought with it profound changes in healthcare service delivery across the U.S. Efforts to enforce social distancing and to increase hospital capacity for the most ill COVID-19 patients led to the temporary shutting down of many medical offices and a rapid transition to telehealth strategies for patient care. Additionally, many hospitals incorporated telehealth to provide access to specialty consultation in the emergency and inpatient units.

To describe these dramatic shifts in the locus, roles, and reasons for seeking care during the pandemic, we used insurance claims data. In this study we used a large de-identified claims data set from Change Healthcare. Change Healthcare provides clearinghouse services to ensure that claims are completed and routed efficiently between providers and insurance companies. By using this upstream data set, we had a near-real-time understanding of patient activities across the United States. We created a dynamic reporting process so that information was published on the C19HCC.org website and updated as rapidly as possible during 2020. This enabled us to inform providers, payers, and regulators of these major transitions in our system of care, allowing them to adjust resources to better meet the needs of patients.

RESEARCH AIMS

1. Evaluate the use of telehealth services and the relative expansion and diminution of the COVID-19 pandemic in the United States for both COVID-19 related conditions and non-COVID-19 conditions.
2. Describe patterns of telehealth service types (e.g., telephone encounters, video visits, acute care remote consultation, home hospital) during the pandemic.
3. Incorporate telehealth data into COVID-19 pandemic models to explore correlations between telehealth use and important clinical outcomes and process measures such as new COVID infection rates, hospitalization rates, recovery location, and death rates.
4. Describe the relative distribution of telehealth services across the United States stratified by payer class, clinician specialty, and geography during key phases of the pandemic.

Growth in Monthly Telehealth Claims. All 50 states showed significant year-over-year growth, from 5x growth in Iowa, to 17x growth in California, to 114x growth in Rhode Island, which saw the highest growth from December 2019 to December 2020.

Total Telehealth Claims by Service Month. During 2019, telehealth use across the country was relatively low but grew slightly month to month. When the COVID-19 pandemic hit in February 2020, there was an immediate and dramatic rise in monthly claims. In January 2020, our claims data set recorded just 590,088 claims—but the number skyrocketed to a high of 12,741,349 in April 2020. This coincided with the temporary closing of many medical practices across the country and the need to move patients out of the hospital to free up inpatient bed capacity for the anticipated influx of acutely ill COVID-19 patients. Telehealth claims peaked in April and began tapering downward in May and June when many medical practices began re-opening.

Telehealth Claims by Clinical Classification of Primary Diagnosis. The study looks at numerous clinical diagnosis categories. Behavioral and mental health disorders was the most common diagnosis category for telehealth prior to the pandemic and then accelerated faster than any other category during the pandemic. At the peak of use in April, we recorded:

• 5,085,295 telehealth claims for behavioral and mental health conditions,
• 1,005,719 telehealth encounters for circulatory system conditions, and
• 843,686 telehealth encounters for endocrine and metabolism disorders.

All categories began experiencing a drop off in telehealth encounter frequency in the spring and summer after the peak in April. Claims stabilized in the fall, then showed an upward trend again in December, associated with the surge in new COVID-19 cases during the holiday season.

Telehealth Claims for Services Delivered In-State vs Out-of-State. Prior to the pandemic, physicians and other licensed health professionals were generally required to hold a license in each state in which they cared for patients using telehealth. During 2019, 71.5% of telehealth claims were from “in-state” and 28.5% from “out-of-state” providers. After license restrictions were lifted in March 2020, both out-of-state and in-state encounters grew sharply, but in-state telehealth grew much faster. By the end of the year, in Oct.- Dec. 2020, the ratio settled in with 93.5% in-state and 6.5% out-of-state.

An executive summary can be viewed below.