Virtual health care is not just for mental health, study finds

Written by University of Utah Health  - original available here

Telehealth visits are commonly used for mental and behavioral health care, and since the days of the early pandemic, patients have increasingly used virtual meetings with doctors to meet other health care needs. But the full scope of who’s accessing health care remotely—and why—is less clear.

A new study of Medicare patients across the country has found that nearly half of telehealth visits are for non-mental health conditions, often chronic conditions like diabetes or high blood pressure. The results provide a crucial foundation to help shape health care policies and practices to make quality care accessible to all.

The results are published in Annals of Internal Medicine.

Many virtual appointments are for common chronic conditions

The researchers examined health care visit data from a nationally representative sample of nearly 15,000 Medicare users during 2021 to 2023 to learn how telehealth is being used nationwide. Nearly half of mental health appointments were performed remotely, amounting to 31 million annual visits. But there were almost as many telehealth appointments for non-mental health conditions: 29 million annually.

The vast majority of these visits were for common health conditions like diabetes and high blood pressure, for which the sheer number of medical visits outweighs the relatively small fraction of these visits that are performed virtually.

“We were surprised at the number of non-mental health conditions, like high blood pressure or diabetes, that were commonly addressed through telehealth,” says Terrence Liu, M.D., M.S., assistant professor of internal medicine at University of Utah Health and the first author on the study. “Even though a smaller percentage of these visits were conducted through telehealth, because these are very common conditions, the total number of estimated visits was very similar to telehealth visits for mental health conditions, numbering in the tens of millions.”

Telehealth may alleviate barriers to care

The data suggests that people who are most medically vulnerable are more likely to use telehealth, the researchers say. Telehealth users are more likely to report limitations in activities of daily living, like bathing and getting dressed, and are more likely to report worse health overall. Liu speculates that telehealth might be especially useful for people with more medical challenges, helping to alleviate barriers to care that these populations might disproportionally face. “If you’re able to receive care at home, then it can potentially overcome some of those barriers,” he says.

The results show that telehealth is an important avenue of care for non-mental health conditions, the researchers say.

Knowing who uses telehealth, and why, can help guide informed decisions about how health systems provide care, which may help lead to more certainty for patients about how their care will be delivered and covered on an ongoing basis.

“Navigating the insurance labyrinth of Medicare, Medicare Advantage, and supplemental plans is already a complicated task for any older adult,” says Alexander Chaitoff, M.D., M.P.H., assistant professor of internal medicine at University of Michigan and second author on the paper. “Having more certainty on whether their telehealth care will be supported on a more permanent basis could be helpful, given how important it is for managing chronic conditions.”

“It’s hard to imagine going back to a world where telehealth is a tiny fraction of all the health care that’s delivered,” Liu says. “It’s not the predominant mode of delivery, and it still has issues that need to be worked out. But I think with greater confidence and support for making telehealth coverage more permanent for non-mental health conditions, health systems will have additional incentive to invest in it and find ways to improve it.”

Liu began the research during his time in the National Clinician Scholars Program at the U-M Institute for Healthcare Policy and Innovation. Chaitoff and senior author Chad Ellimoottil, M.D., M.S., are current members of IHPI.

The research is published in Annals of Internal Medicine, “Telehealth Utilization and Health Conditions Addressed Among the U.S. Medicare Population.”, DOI:10.7326/ANNALS-25-05028

This work was supported by the Department of Veterans Affairs, Veterans Health Administration, Health Services Research & Development Service.