effects of the covid-19 pandemic on telehealth

Effects of the COVID-19 Pandemic on Telehealth

April 2021

Telehealth ObservationsAfter spiking in March 2020, the share of all ambulatory health visits conducted

virtually leveled off and ranged between 19-25% through January 2021.

– Prior to March 2020, virtual health represented only 0.3% of ambulatory visits.

– The volumes of ambulatory visits fell around the 3rd week of March 2020.

Organizations responded by shifting visits to the virtual environment, either with

telephone or video approaches.

– In the 4th quarter of 2019, only about 25,000 telehealth visits per month were performed by all

organizations. More than 2 million visits were recorded just in April of 2020.

▪ Only 8 organizations billed more than 8,000 telehealth visits in all of 2019. Members averaged

12,000 visits in April of 2020 alone.

– Telephone visits provided an opportunity to easily pivot to virtual. 29% of the virtual visits in April

2020 were telephone-only. By October, that had dropped to 17%.

– Even organizations with established Telehealth programs used telephone encounters to scale

upward.

Some clinical areas were better able to utilize telehealth than others.

– In April of 2020, specialty areas like Primary Care, Cardiology, Behavioral Health and Neurology

performed more than 70% of their ambulatory visits virtually.

– As in-person visits rose to near-normal in September and October, Behavioral Health and

Neurology retained telehealth as an approach with 63% and 33% virtual visits, respectively.

Vizient Presentation │ April 20212

Telehealth Key Takeaways

Behavioral Health and Neurology virtual visits have remained high.

– While virtual visits in many areas dropped after their early peak, Behavioral Health and

Neurology appointments represented 68% and 40% of visits in January 2021, respectively.

Consumer preferences forecast continued utilization of virtual environment.

– According to a January 2021 survey, 78% indicated a desire to continue virtual visits once the

crisis abates, while 93% said they were likely to continue video sessions moving forward with

existing providers.

– Vizient projects a continued rise in virtual sessions over the next decade, with levels matching or

exceeding peak pandemic levels.

Social determinants of health, including access to reliable internet, continues to

impact access to care.

– Increased access to broadband may increase availability/uptake of telehealth.

– Medicare patients were more likely than commercially insured or Medicaid to use phone visits for

their virtual visits.

– Medicaid patients had less virtual visits than commercially insured and Medicare patients.


Virtual visit volumes were relatively low in the pre-pandemic years, but were on the rise

4

Source: CPSC (Q1 2017-Q4 2019)

24,405 25,492 28,36233,915

41,420 43,005 41,776

52,189

61,73168,518 68,582

76,338

Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4

2017 2018 2019

Virtual Visit Volumes by Quarter 2017-2019Based on 153,244 providers and more than 700M patient encounters

AAMC-Vizient Clinical Practice Solutions Center │April 2021

Beginning in March the share of virtual health visits to all visits rose, peaking in April 2020


0.3% 0.3%

14%

65%

49%

30%

25%22%

20% 19% 20%24% 22%

Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan

2020 2021

% of Ambulatory Virtual Visits by Month66.6 million visits - 96,500 providers - 18,000 locations

Includes all visits with Site of Service: Telehealth, Office, On Campus Outpatient Hospital and Off Campus Outpatient

Hospital. Standard visit codes (e.g. 99211-99215) are categorized as online visits if billed with telehealth service site

or modifier.

Without the shift to virtual care, more than 200,000 patient visits would not have taken place in April

6

Total ambulatory visits dropped 41% in April with virtual visits accounting

for 65% of the completed visits.


Includes all visits with Site of Service: Telehealth, Office, On Campus Outpatient Hospital and Off Campus Outpatient

Hospital. Standard visit codes (e.g., 99211-99215) are categorized as online visits if billed with telehealth service site

or modifier.

0

1,000,000

2,000,000

3,000,000

4,000,000

5,000,000

6,000,000

7,000,000

Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec

2020 CPSC Member Monthly Visit Volumes66.6 million visits - 96,500 providers - 18,000 locations

In Person

Phone

Online

Behavioral Health virtual visits remained high across the year


Includes all visits with CMS Site of Service: Telehealth, Office, On Campus Outpatient Hospital and Off Campus

Outpatient Hospital.

Neurology also maintained high proportions of virtual visits throughout

the year.

65%71%

40% 41%

49%45%

40%

79% 79%83%

22% 24%

13%6%

15% 17%10%

17%

68%

40%

0%

20%

40%

60%

80%

100%

% of Ambulatory Visits Delivered VirtuallyTop 10 Specialties by Volume

26.9 million visits - 96,500 providers - 18,000 locations

20-Apr 20-Jul 20-Oct Jan-21

Observations on the Impact of Organization Size on Telehealth Utilization

8 Vizient Presentation │ April 2021

Larger organizations appeared to ramp virtual care up faster and sustained virtual services at a slightly higher level in 2020


0%

10%

20%

30%

40%

50%

60%

70%

80%


Percent of Ambulatory Visits Via Telehealth62.1 million visits - 96,500 providers - 18,000 locations

Small Organizations (<1,000 providers) Large Organizations (>1,000 providers)

Small organization cohort included 24 organizations and 17,500 providers. Large organization cohort included 39

organizations and 79,000 providers.

Across the second half of 2020 larger organizations were better able to return to pre-pandemic visit levels


-22%

-41%

-29%

-4%1% -2%

4%11%

-1% 2%

-60%

-40%

-20%

0%

20%

0

2,000,000

4,000,000

6,000,000


% o

f F

eb

Vo

lum

e

Vis

it V

olu

me

Ambulatory Visit Volumes Large Organizations (>1,000 providers)

-21%

-41%-30%

-10%-5% -8%

-2% 1%-10% -9%

-60%

-40%

-20%

0%

20%

0

500,000

1,000,000

1,500,000


% o

f F

eb

Vo

lum

e

Vis

it V

olu

me

Small Organizations (<1,000 providers)

In Person Online Phone % of February Volume

Larger organizations consistently had a higher percentage of ambulatory encounters performed virtually


Small Orgs (<1,000 providers) Large Orgs (> 1,000 providers)

% of Feb Volume % Telehealth % of Feb Volume % Telehealth

Feb 0% 0%

Mar -21% 11% -22% 15%

Apr -41% 56% -41% 67%

May -30% 38% -29% 51%

Jun -10% 23% -4% 32%

Jul -5% 21% 1% 26%

Aug -8% 19% -2% 23%

Sep -2% 17% 4% 21%

Oct 1% 15% 11% 20%

Nov -10% 17% -1% 21%

Dec -9% 20% 2% 24%

As COVID-19 cases rose at year’s end, the increased levels of virtual care helped larger

organizations maintain their levels of visits and serve more patients.

Consumer preference and projected shift to virtual care


January survey reveals significant drop in consumer comfort level with on-site health care

21%

would proceed with

surgery today, a

significant decline

from September

59%

indicate telehealth is

their preferred setting,

remaining consistent

since July

33%

feel safe visiting an emergency

department today, down from 54% in July

Over 67%

feel safe receiving a face-to-face visit in a

physician’s office, down from 84% in September

A Vizient and Sg2 Presentation │ April 2021

13

TodayMay 2020

survey

July

2020

survey

Sept

2020

survey

Jan

2021

survey

Very/somewhat

safe60% 73% 82% 50%↓

In three

months

Very/somewhat

unsafe6% 18% 13% 27%↑

How safe would you feel if you or a family member

went to your preferred hospital for an elective

(nonurgent) procedure?

Sources: Sg2 and Vizient Patient and Physician Advisory Council Survey, Sg2 analysis, January 2021, Vizient

CPSC.

https://www.vizientinc.com/-/media/documents/sitecorepublishingdocuments/public/disasterresources/connecting_with_patients_during_covid19.pdf

Consumer preferences during COVID-19 reveal opportunity to rethink longstanding approaches

14

What services would you like to see

continued once this crisis abates?

78%

48%

66%

34%

71%

0% 50%

Virtual Visits

Drive-Through Testing

No Waiting Room

Robust Home Care

Face-to-Face Visits

How likely are you to seek virtual services

using the following formats?

92%

56%

93%

63%

0% 20% 40% 60% 80%

Asynchronous Visit–

Existing Provider

Asynchronous Visit–

New Provider

Video Visit–

Existing Provider

Video Visit–

New Provider

Sources: Sg2 and Vizient Patient and Physician Advisory Council Survey, Sg2 analysis,

January 2021, Vizient CPSC.

A Vizient and Sg2 Presentation │ April 2021

https://www.vizientinc.com/-/media/documents/sitecorepublishingdocuments/public/disasterresources/connecting_with_patients_during_covid19.pdf

Cardiovascular

Women’s Health

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

50%

55%

2019 2024 2029

Shift to Virtual Is Variable Across Service Line Groups

Source: Sg2 Analysis, 2021.

Virtual Visit Shift by Service Line Group

US Market, 2019–2029

1-Year 10-Year

Behavioral Health

Neurosciences

Medicine

Surgery

Cancer

Orthopedics

Spine

2020 CPSC Data

Observations on Telehealth for Primary Care, Behavioral Health and Neurology


Primary Care Observations

• In-person ambulatory visits dropped 79% from February to April 2020.

• Of the visits that still occurred in April 2020, 65% were virtual. By January

2021, this was down to 22%.

• In this same time period, general exams by primary care providers dropped

86%. By July, these visits had nearly returned to pre-pandemic levels.

General exam visits were almost entirely in-person, just 4% virtual by the

fall.

• Primary care visits for patients with diagnoses of “Exposure to

communicable diseases,” which includes COVID-19, started rising in April

and remained high through the summer, with a second spike starting in

October as COVID cases surged.

• Primary care visits for hypertension and Type 2 Diabetes, chronic

conditions requiring sustained care, remained relatively high, with just 35%

and 42% drops from February to April.


In April 2020, primary care provider visits for communicable disease exposure (which included COVID-19) began to rise and remained high through the end of 2020


Includes visits with primary care providers and CMS Site of Service: Telehealth, Office, On Campus Outpatient

Hospital and Off Campus Outpatient Hospital.

0

20,000

40,000

60,000

80,000

100,000


2020 Primary Care Provider VisitsSuspected exposure to communicable diseases

15.7 million visits - 12,000 primary care providers - 3,100 locations

In Person

Online

Phone

Behavioral Health Observations

• While overall ambulatory visits fell 41% from February to April, Behavioral

Health specialties (Psychiatry, Psychology and Social Work) fell by just

13% due to a rapid shift to virtual health.

• In April, 80% of Behavioral Health visits happened virtually, and remained

high at 69% in December.

• Visits for conditions pertaining to stress, depression and anxiety rose

across the year until peaking in October.


Without the shift to virtual visits, 165,000 behavioral health encounters may have been lost in April 2020

20

Includes visits with behavioral health providers, including psychologists, psychiatrists and social workers and CMS

Site of Service: Telehealth, Office, On Campus Outpatient Hospital and Off Campus Outpatient Hospital.


0

50,000

100,000

150,000

200,000

250,000

300,000


2020 Behavioral Health VisitsAll Diagnoses

2.8 million visits - 4,000 providers - 1,500 locations

In Person Online Phone

Neurology Observations

• Neurology specialty total patient activity dropped 29% in April from

February but had returned to normal levels by the fall of 2020.

• In April 2020, 84% of Neurology visits were virtual and were still at 41%

virtual by December.

• The largest drop in activity was seen for general complaints of cognitive

function and awareness while chronic conditions such as migraine,

epilepsy, Parkinson’s and MS held fairly steady but with a significant shift

to virtual delivery.

• Care for Epilepsy, MS and Migraines saw a 13% drop in activity in April

2020, but with 89% of visits virtual. Parkinson’s disease saw a slightly

higher drop in all activity (24%) with 88% occurring virtual.

• Neurology chronic care was still 40% virtual by the fall of 2020.


Neurology visits for non-chronic care saw a large drop in volume in April 2020


Neurology visits for ‘other symptoms involving cognitive functions and

awareness’ includes patients seeking evaluation and treatment for non-

disease specific, or currently undiagnosed neurological concerns.

Includes visits with neurology providers and CMS Site of Service: Telehealth, Office, On Campus Outpatient Hospital

and Off Campus Outpatient Hospital.

0

5,000

10,000

15,000


Neurology VisitsOther symptoms involving cognitive functions and awareness

2 million visits - 2,900 providers - 1,000 locations

Phone

Online

In Person

Observations on Demographics for Telehealth Users


Older patients have the highest volume of total visits but lower rates of telehealth than other adults by December 2020




55%

18%20%

65%

28% 29%

67%

24% 25%

67%

20% 21%

63%

20% 21%

0

200,000

400,000

600,000

800,000

1,000,000

1,200,000

1,400,000

1,600,000

1,800,000

Apr-20 Aug-20 Dec-20 Apr-20 Aug-20 Dec-20 Apr-20 Aug-20 Dec-20 Apr-20 Aug-20 Dec-20 Apr-20 Aug-20 Dec-20

0 - 20 21 - 40 41 - 60 61 - 80 81+

Ambulatory Volume by Patient Age RangeApril, August and December 2020

14.1 million visits – 96,500 providers – 18,000 locationsIn Person Telehealth

All ages saw fewer phone visits as a percentage of overall telehealth in Dec as acceptance and availability shifted


17%

17%

24%41%

55%0

200,000

400,000

600,000

800,000

0 - 20 21 - 40 41 - 60 61 - 80 81+

Telehealth Delivery By Patient Age3.4 million visits – 96,500 providers – 18,000 locations Online Phone

6%

8% 14% 29%

44%0

200,000

400,000

600,000

800,000

0 - 20 21 - 40 41 - 60 61 - 80 81+

April

2020

Decem

ber

2020



Medicaid patients had less virtual visits than commercial and Medicare patients




69%

56%68%

55%

25%

19%

22%

25%

27%

21%

23%

24%

0

500,000

1,000,000

1,500,000

2,000,000

2,500,000

3,000,000

Co

mm

erc

ial

Me

dic

aid

Me

dic

are

Self

Pa

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Co

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Me

dic

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Me

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Apr-20 Aug-20 Dec-20

Ambulatory Visits by Payer Type19.9 million visits - 96,500 providers - 18,000 locations

In Person

Medicare patients were more likely than Commercial or Medicaid to use phone visits for their virtual visits




17%

19%

47%

35%

10%

14%

35%

25%

9%

12%

34%

19%0

200,000

400,000

600,000

800,000

1,000,000

1,200,000

Co

mm

erc

ial

Me

dic

aid

Me

dic

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Self

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Apr-20 Aug-20 Dec-20

Virtual Visit Delivery By Payer4.7 million visits - 96,500 providers - 18,000 locations Online Phone

Methodology – Data Identification

Unless noted otherwise, the data reported in this presentation was

derived from the Clinical Practice Solutions Center (CPSC) developed by

the Association of American Medical Colleges (AAMC) and Vizient.

Based on clinician professional fee billing data, these views represent

activity captured from 96,500 physicians in 18,000 locations.

For this reporting:

• Visits include any billed patient evaluation and management visit

CPT® code eligible for telehealth via CMS or commercial carriers.

• Ambulatory includes CPT Codes billed at one of the following CMS

Sites of Service: Telehealth, Office, On Campus Outpatient Hospital or

Off Campus Outpatient Hospital. All other sites of service, including

inpatient and emergency room, were excluded from the evaluation.

28

CPT® is a registered trademark of the American Medical Association


Methodology - Telehealth Visit Identification

For this evaluation, telehealth includes any synchronous care, i.e. live, real-time

settings where the patient interacts with a provider via phone or video.

• Phone visits include a provider using audio only real-time communication.

These are identified using specific CPT codes (98966-98968, G0406-G0408,

G0459, G2012, 99441-99443 and G0071). CMS also approved additional

codes for audio-only service but did not provide coding to distinguish between

audio only or online visits, so will be included in online visits below.

• Online visits include a provider using an interactive audio and video

telecommunications system that permits real-time communication. These

visits are flagged as telehealth using the telehealth CMS place of service,

specific telehealth modifiers and/or CPT codes designated for online visits.


This information is proprietary and highly confidential. Any unauthorized dissemination,

distribution or copying is strictly prohibited. Any violation of this prohibition may be subject

to penalties and recourse under the law. Copyright 2020 Vizient, Inc. All rights reserved.

Copyright 2021 Vizient, Inc. All rights reserved

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