Monthly Telehealth Regional Tracker Completes Full Year of Data

FAIR Health’s Monthly Telehealth Regional Tracker, launched last May as a free service, has now collected a complete 12 months of data for 2020. This enables a look back at the evolution of telehealth from January to December 2020—largely in response to COVID-19—as compared to the same months in 2019.

For each month of 2020, the Telehealth Tracker has presented five infographics—one for the United States; one each for the four US census regions (Midwest, Northeast, South, West)—comparing that month to the corresponding month in 2019. Each infographic combines information on the volume of telehealth claim lines, urban versus rural usage, top five diagnoses and top five procedure codes. Since its launch, the Telehealth Tracker has drawn widespread media attention from outlets such as the New York Times, Forbes, TIME, POLITICO and Business Insider. It has also been cited in research published by the National Governors Association and journals such as JAMA and the HCA Healthcare Journal of Medicine.

Here are some of the major Telehealth Tracker findings of 2020.

Spring 2020
In March 2020, at the start of the spring wave of the COVID-19 pandemic, telehealth began to grow rapidly. Telehealth claim lines increased 4,347 percent nationally from 0.17 percent of medical claim lines in March 2019 to 7.52 percent in March 2020. In an indication that the growth was related to the COVID-19 pandemic, the increase was even greater (15,503 percent) in the Northeast, where the pandemic hit hardest in March.

Telehealth reduced the risk of COVID-19 transmission associated with in-person visits. For that reason, patients and providers turned to it, federal and state regulations related to telehealth were relaxed, and private payors expanded access to telehealth. In addition, widespread restrictions on elective in-person procedures made telehealth a viable option.

In April 2020, when those restrictions continued in much of the country, telehealth grew even more sharply. Telehealth claim lines increased 8,336 percent nationally, from 0.15 percent of medical claim lines in April 2019 to 13.00 percent in April 2020.

In May 2020, many of the restrictions on elective in-person care expired. Telehealth had another large year-to-year increase—telehealth claim lines increased 5,680 percent nationally from 0.15 percent of medical claim lines in May 2019 to 8.69 percent in May 2020—but the increase was not as large as from April 2019 to April 2020. On a month-to-month basis, telehealth claim lines fell 33 percent nationally from April to May 2020. Nevertheless, the pandemic continued and telehealth usage remained high by comparison with 2019.

The top five telehealth diagnoses that spring indicated that telehealth was being used for conditions that had not been among the top five the year before—such as hypertension, diabetes mellitus, joint/soft tissues diseases and issues, and developmental disorders. Mental health conditions, already the number one telehealth diagnosis nationally and in every region since March 2020, accounted for an even larger share of telehealth claim lines by May 2020.

Summer 2020
In the summer months of June to August 2020, telehealth continued to have large year-to-year increases—smaller than during the spring wave, but substantial enough to show telehealth’s staying power. For example, telehealth claim lines increased 3,552 percent nationally from August 2019 to August 2020, rising from 0.17 percent of medical claim lines in August 2019 to 6.07 percent in August 2020.

Trends in the four US census regions (Midwest, Northeast, South and West) were similar to those in the nation as a whole. In each region in June and July, there were large percent increases in volume of claim lines from year to year, but small drops in volume of claim lines from month to month. In August, there were month-to-month variations somewhat commensurate with changes in the pandemic—for example, rising the most (9.7 percent) in the South, which was particularly hard-hit in the summer; falling the most (7.7 percent) in the Northeast, which had experienced its peak of cases in the spring.

Mental health conditions continued to rise as a share of all telehealth diagnoses, growing nationally from 45.39 percent to 48.93 percent from July to August 2020. In July, substance use disorders emerged as one of the top five telehealth diagnoses, though only in the Northeast.

Fall 2020
In the fall, telehealth maintained its pattern of large, though declining, increases compared to the year before. For example, telehealth claim lines increased 2,938 percent nationally from November 2019 to November 2020, rising from 0.20 percent of medical claim lines in November 2019 to 6.01 percent in November 2020.

From month to month, coinciding with a surge in COVID-19 cases in October, the telehealth share of medical claim lines rose 10.6 percent nationally from September to October 2020. There were large year-to-year and smaller month-to-month increases in each region as well. Month-to-month growth continued in November nationally and in all regions but the South.

In October 2020, exposure to communicable diseases became one of the top five telehealth diagnoses nationally and in every region. This was likely related to the October surge in COVID-19 cases, as patients contacted providers via telehealth out of concern they had been exposed to COVID-19.

In November 2020, COVID-19 appeared for the first time on one of the regional lists of top five telehealth diagnoses, ranking fourth in the Midwest. Its appearance may have reflected the growing number of COVID-19 cases and relatively fewer telehealth visits for other conditions, such as the flu, cases of which had been unusually low.

Winter 2020
In December 2020, telehealth claim lines increased 2,817 percent nationally from December 2019 to December 2020, rising from 0.22 percent of medical claim lines in December 2019 to 6.51 percent in December 2020. On a month-to-month basis, the telehealth share of claim lines rose 8.3 percent nationally from November to December 2020. In each region, there were large percent increases in volume of telehealth claim lines from December 2019 to December 2020; smaller increases occurred from November to December 2020 in every region but the Midwest.

In December 2020, COVID-19, for the first time, became one of the top five telehealth diagnoses nationally and in every region. Mental health conditions continued to be the number one telehealth diagnosis nationally and in every region. Exposure to communicable diseases continued to be number two on the national list of telehealth diagnoses and to appear in the top five in all regions.

There were no changes nationally or by region from November to December 2020 in the top five procedure codes, even though there had been changes in at least some regions in previous months. This suggested that the telehealth procedures being performed might have stabilized by December.

FAIR Health President Robin Gelburd commented: “FAIR Health’s Monthly Telehealth Regional Tracker now provides a complete picture of the year 2020 in comparison to 2019. As the COVID-19 pandemic persists, we will continue to monitor how the pandemic affects the evolution of telehealth.”

For the Monthly Telehealth Regional Tracker, click here.