This past month, the U.S. Department of Health and Human Services Office of Inspector General released a study examining how Medicare beneficiaries used telehealth during the first year of the COVID-19 pandemic.

By analyzing Medicare fee-for-service claims data and Medicare Advantage encounter data from March 1, 2020, to February 28, 2021, along with those from the same period the year prior, the agency calculated the total number of services used via telehealth and in-person, as well as the types of services used.

"Telehealth was critical for providing services to Medicare beneficiaries during the first year of the pandemic," read the report. "Beneficiaries’ use of telehealth during the pandemic also demonstrates the long-term potential of telehealth to increase access to healthcare."

Healthcare IT News sat down with OIG analyst John Gordon to discuss the takeaways of the study and how the information the organization found may help decision makers in shaping future telehealth policies.

Q. What compelled the team to look into beneficiaries' use of telehealth?

A. This report is part of an extensive body of work that our organization is conducting on telehealth. It's part of a series looking at the use of telehealth during the first year of the pandemic. It'll be accompanied by two reports that are expected to be released in the coming months: one looking at the characteristics of beneficiaries that use telehealth and Medicare, the other looking at program integrity risks associated with the use of telehealth.

With the temporary flexibilities from HHS and the Centers for Medicare and Medicaid Services, as well as the impact of the pandemic on telehealth use, we really wanted to kind of do a deep dive and to see, "OK, how many beneficiaries are using telehealth? What does it look like in comparison to their use of equivalent in-person services? And how has their use of telehealth changed during that first year of the pandemic compared to the year prior?"

So that's really what drove us to do this work.

Q. What were some of the top-level findings?

A. Over 28 million Medicare beneficiaries used telehealth during the first year of the pandemic. This was more than two in five enrolled Medicare beneficiaries.

Beneficiaries used 88 times more telehealth services during the first year of the pandemic than they used in the year prior.

And overall, beneficiaries used telehealth to receive 12% of their services during the first year of the pandemic.

When it comes to the types of services that beneficiaries are using, beneficiaries most commonly used telehealth for office visits, which accounted for just under half of all telehealth services during the first year of the pandemic.

However, it was beneficiaries' use of telehealth for behavioral health services that stood out. And that was because beneficiaries used telehealth for a larger share of their behavioral health services, compared to their use of telehealth for other services.

Q. Can you weigh in why you think behavioral care has emerged as one of the main use cases for telehealth?

A. The COVID-19 pandemic has increased the need for mental health and substance use disorder treatment services throughout the nation. And clearly, many people, including Medicare beneficiaries, are struggling. So as a part of our study, we looked at how Medicare beneficiaries accessed both mental health and substance use disorder services during the first year of the pandemic. And as I was alluding to earlier, we found that beneficiaries received more than 40% of all behavioral health services using telehealth.

This was far more than for other services. For example, just 13% of office visits were through telehealth.

The way that we see it is that these data show that telehealth may serve as an important tool to address mental health needs for Medicare beneficiaries. So we were really struck by this information as it related to behavioral health and telehealth when we were analyzing the data.

Q. How did audio-only services come into play?

A. We found that audio-only services did play an important role during the first year of the pandemic, especially when beneficiaries may face barriers to receiving in-person care. In fact, one-quarter of all of the telehealth services used during the first year of the pandemic were audio-only services.

However, we want to note that as policymakers consider the future of audio-only services, it's really important to take a deeper look at these services in particular, including utilization patterns, their impacts on quality of care, and any associated program integrity risks.

Q. What broader conclusions might you be able to draw from this data about the general population?

A. Because we're looking just at Medicare beneficiaries here, it's hard to kind of extrapolate that out to the broader American population. But what I can say is some of our conclusionary points, which are that we feel that the use of telehealth during the pandemic shows its long term potential to increase access to healthcare, particularly for those behavioral health services that we were just discussing. 

And we're really hoping that decision makers, such as Congress and the Centers for Medicare and Medicaid Services, carefully consider both the data that we present in our report as well as other available data when they're making decisions about the future of telehealth policy.

Q. Was there anything that surprised you in the report?

A. That's a good question. I think I was surprised to see the difference in the overall share of people using behavioral health via telehealth versus the use of telehealth for other services. I know there are a lot of outstanding questions about how telehealth could substitute for in-person care, how it couldn't substitute for in-person care, and so on and so forth.

I found it really notable that over 40% of all beneficiaries use telehealth to receive their behavioral healthcare. Whereas we present that 12% of all healthcare services used by beneficiaries during the first year of the pandemic, was through telehealth.

So overall, most care remained in-person, but for behavioral health services, it was really quite different. So I would say that was something that surprised me about the data.

Q. Are there any other elements of the report that you feel are particularly notable?

A. One aspect of the report that we were really happy to be able to do is that it includes the use of telehealth by beneficiaries in both Medicare fee-for-service and Medicare Advantage. So when we're presenting this information, it's really gauging the use of telehealth amongst the entire Medicare population, rather than just a segment. We're really excited to be able to include these totals for the entire medical population.

Kat Jercich is senior editor of Healthcare IT News.
Twitter: @kjercich
Email: kjercich@himss.org
Healthcare IT News is a HIMSS Media publication.