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Use of Non-Hospital-Based Provider-to-Patient Telehealth Grew Nearly 1400% From 2014 to 2018, FAIR Health Finds

Robin Gelburd, JD, is the President of FAIR Health, a national, independent nonprofit organization with the mission of bringing transparency to healthcare costs and health insurance information. FAIR Health possesses the nation’s largest collection of private healthcare claims data, which includes over 31 billion claim records contributed by payers and administrators who insure or process claims for private insurance plans covering more than 150 million individuals. Certified by CMS as a national Qualified Entity, FAIR Health also receives data representing the experience of all individuals enrolled in traditional Medicare Parts A, B and D; FAIR Health houses data on Medicare Advantage enrollees in its private claims data repository. Gelburd is a nationally recognized expert on healthcare policy, data and transparency.
From 2014 to 2018, private insurance claim lines1 for non-hospital-based provider-to-patient telehealth grew 1393%, according to a new white paper on telehealth from FAIR Health, a national, independent nonprofit organization dedicated to bringing transparency to healthcare costs and health insurance information. The study draws on data from FAIR Health’s comprehensive repository of over 29 billion private healthcare claim records—the largest in the country.

This increase was the largest of 4 types of telehealth studied, and a larger increase than that for telehealth overall. The increase was greater in urban than rural areas. Claim lines for non-hospital-based provider-to-patient telehealth increased 1227% in urban areas, and 897% in rural areas.

The 4 types of telehealth—the remote provision of clinical services through telecommunications technology—studied in the white paper were:

 
  • Provider-to-patient–non-hospital-based telehealth. The provider and the patient communicate via telehealth without relation to a hospital. For example, a patient who is home and has not had a recent hospitalization has a video chat with a provider who looks at the patient’s rash.
  • Provider-to-patient–discharge telehealth. The telehealth visit is a follow-up after the patient is discharged from an inpatient stay in the hospital.
  • Physician-to-patient–emergency department (ED)/inpatient telehealth. The patient is in the hospital, whether in the ED or as an inpatient, communicating via telehealth with a physician.
  • Provider-to-provider telehealth. The telehealth exchange involves consultation between healthcare professionals.
The telehealth white paper expands on a previous FAIR Health white paper that reported on telehealth and other alternative venues of care, such as urgent care centers and retail clinics. The new white paper provides additional details, delving into the different types of telehealth, the most common telehealth diagnostic categories and what happens to patients after a telehealth visit.

Among the findings of the new study:

Claim lines related to telehealth overall grew 624% from 2014 to 2018 (Table 1).

Table 1. Claim Lines With Telehealth Usage by Type as a Percentage of All Medical Claim Lines, 2014-2018



Source: FAIR Health

In 2018, non-hospital-based provider-to-patient telehealth accounted for 84% of all telehealth claim lines, compared with 52% in 2014.

In the period 2014-2018, the age group most associated with telehealth overall were those 31 to 40 years of age, who accounted for 21% percent of the distribution of all telehealth claim lines ( Table 2). But most of the claim lines (82%) for discharge-related provider-to-patient telehealth were associated with those 51 years of age and older.

Table 2. All Telehealth Claim Lines by Age Group, 2014-2018



Source: FAIR Health

Sixty-five percent of all telehealth claim lines in the period 2014-2018 were associated with females. But for telehealth visits associated with a hospital discharge, 53% of claim lines were submitted for females.

The top 3 reasons individuals sought treatment from a provider via non-hospital-based telehealth, from most to least common, were acute upper respiratory infections, mood (affective) disorders, and anxiety and other nonpsychotic mental disorders (Table 3).

Table 3. Distribution of Non-Hospital-Based Provider-to-Patient Telehealth Claim Lines by Mid-Level Diagnostic Category, 2018



Source: FAIR Health

In 2018, the telehealth diagnosis with the highest rate of patients who had an in-person visit within 15 days of a non-hospital-based provider-to-patient telehealth visit for the same or a very similar diagnosis was heart failure (Table 4).

Table 4. Top Telehealth Diagnoses for Which a Patient Had an In-Person Follow-Up Visit with a Provider for the Same or a Very Similar Diagnosis within 15 Days of a Non-Hospital-Based Provider-to-Patient Telehealth Visit, 2018



Source: FAIR Health

As telehealth continues its rapid growth, we are pleased to use our unparalleled data repository to uncover layers that have been difficult to study. We offer the information in this report for the benefit of all healthcare stakeholders with an interest in the emergence and contours of telehealth.

Note

1. A claim line is an individual procedure or service listed on an insurance claim.

Author Information 

Robin Gelburd, JD, is the president of FAIR Health, a national, independent nonprofit organization with the mission of bringing transparency to healthcare costs and health insurance information. FAIR Health possesses the nation’s largest collection of private healthcare claims data, which includes over 29 billion claim records contributed by payors and administrators who insure or process claims for private insurance plans covering more than 150 million individuals. Certified by the Centers for Medicare & Medicaid Services (CMS) as a national Qualified Entity, FAIR Health also receives data representing the experience of all individuals enrolled in traditional Medicare Parts A, B and D; FAIR Health houses data on Medicare Advantage enrollees in its private claims data repository. Robin is a nationally recognized expert on healthcare policy, data and transparency.


 
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