Recent policy changes have increased the use of telehealth tools, but the technology remains relatively uncommon. A new study sheds some light on a more efficient policy path for driving widespread adoption in certain medical specialties.
Proposals from CMS aimed at broadening reimbursement for virtual services have received positive reviews from telehealth advocates. Those proposals have also met skepticism from some doctors, however. A research letter in the latest issue of JAMA suggests both groups have a point: the benefits of reimbursement appear to vary depending on the subspecialty involved.
Based on a study reviewing commercial insurance claims data between 2005 and 2017 from a "large, private US health plan," researchers tracked a notable uptick in the use of telemedicine among primary care physicians between 2015 and 2017. While that period saw expanded coverage for direct-to-consumer telemedicine, the data showed a negative association with states that enacted comprehensive parity laws mandating reimbursement for the services.
Researchers did not name the insurer, but data was collected from OptumLabs Data Warehouse, which is owned by UnitedHealth.
Meanwhile, telemental health services saw a steadier increase between 2005 and 2017, and accounted for 53% of the visits tracked over the period. Those cases appeared to square with the more traditional expectation that telehealth would benefit rural areas with a relative scarcity of practitioners. By contrast, the increase in usage among primary care patients was more frequent among younger, urban patients.
That split decision suggests effective policy approaches might carefully consider the subspecialty involved, according to the study’s first author, Michael L. Barnett, M.D., assistant professor of health policy and management at the Harvard T. H. Chan School of Public Health.
“Rural, low-supply areas have the highest telemental health demand and broad parity laws are associated with higher adoption,” he told FierceHealthcare. “Therefore, going further with reimbursement and lowering barriers may help telemental health expand.”
When it comes to primary care, however, the study’s results suggest consumer demand for the technology’s convenience already exists and has begun to pick up its pace.
“For primary care, it’s a totally different story with huge consumer adoption across the map—we probably don’t need any policy to influence that,” Barnett said.
While adoption has been relatively slow, Barnett believes a continuation of the trends seen in the past several years will make the technology ubiquitous within the next decade or so. If so, the rapid expansion of telehealth among primary care patients may indicate that resistance to the technology has come at least in part from hard-to-change attitudes and habits among patients.
“In terms of what might be limiting broader uptake, it can take time for some new ideas to take hold," he said. "Many patients in the US are fundamentally more comfortable being treated by a clinician face-to-face than a doctor by video or text chat; it will take time for that preference to change."