Chad Ellimoottil’s research on telehealth helps inform virtual care policy and practice at the institutional, state, and national levels.
Telehealth remains a convenient option for patients following the COVID-19 pandemic.
Regular check-ins with your doctor are vital for maintaining good health and treating illness. During the COVID-19 pandemic, the rapid expansion of telehealth made connecting with your doctor both safe and convenient. As the pandemic subsided, use of telehealth declined but still accounts for roughly 10% of all medical appointments in the U.S. Telehealth continues to be a convenient way to receive care for many patients, especially those who live far from their doctor’s office, have physical challenges, difficulty with transportation or missing work, or face other obstacles.
Chad Ellimoottil, M.D., M.S., associate professor of urology at Michigan Medicine, works to understand telehealth’s changing role in U.S. healthcare. As Medical Director of Telehealth for Michigan Medicine who oversees over 450,000 virtual care visits annually and a researcher with more than 90 scientific publications informed by clinical experience, Ellimoottil explores the barriers, benefits, and limitations of telemedicine. He actively engages with institutional, state, and national policy leaders and other stakeholders to inform policy and help ensure telehealth is a sustainable and beneficial service for patients and clinicians alike. In recognition of his many contributions and impact, Ellimoottil was named a recipient of the Institute for Healthcare Policy & Innovation’s 2024 Policy Impact Award.
Telehealth, COVID-19, and the Post-Pandemic World
Telehealth is the use of communications technologies such as video calls, phone calls, and patient portals to remotely connect patients and providers outside of traditional medical settings.
Since 2016, Ellimoottil’s research has shown telehealth is a feasible treatment option for a variety of urological conditions that can also help improve patient satisfaction and reduce costs. His early work found telemedicine may also expand the number of patients clinicians are able to see by reducing turnover time between appointments, and may reduce patient readmissions as well.
Despite promising findings, concerns of potential patient overuse, clinician and patient unfamiliarity with necessary technologies, and other unresolved questions slowed the widespread expansion of telehealth. Adoption was further complicated by several pre-pandemic barriers, including restrictions on interstate licensure, which prevented providers from treating patients across state lines, and a lack of payment parity between virtual and in-person services. Additionally, virtual services would often only qualify for reimbursement if they were provided for certain conditions or patient groups, such as established patients and those in rural areas.
The Centers for Medicare and Medicaid Services temporarily eased many of these restrictions during the 2020 public health emergency, leading to an increase in the number of patients accessing care virtually. Following this change, telehealth usage increased from 11,000 Medicare patients in March 2020 to 1.3 million the following month. Experts estimate approximately 1 billion telehealth visits occurred overall in the U.S. that year.
Ellimoottil’s research during this period of unprecedented telehealth expansion highlighted its viability for a range of services and specialties, including pre-surgery urological consultations, follow-up infertility appointments, and providing mental and behavioral health services to those with Sickle Cell Disease. He also found these technologies can help clinicians and other specialists consult with one another to expedite care and reduce in-person patient visits.
His work showed patients who received care virtually during the pandemic were enthusiastic about telehealth’s benefits and quality. In one study, urologic cancer patients believed telehealth was both convenient and cost-effective, and in another patients with gastrointestinal conditions felt virtual care was comparable to in-person services. He also demonstrated that use of telehealth in primary care may reduce low-value care services and does not lead to a significant increase in patients seeking emergency treatment.
Providers’ views on telemedicine, however, are slightly more mixed. While many recognize the value of telehealth, they emphasize the importance of being able to identify when it is and is not an appropriate treatment option. Improved efficiency, better access to care, and reduced costs are all cited as potential benefits, but some clinicians remain concerned about care quality, patients’ technological limitations, and a potential increase in the risk of malpractice.
As telehealth’s role in the future of U.S. healthcare continues to unfold, Ellimoottil’s findings indicate that improving patients’ ability to access and use relevant technologies, developing strategies to improve equity – such as continuing coverage of audio-only telehealth – and maintaining pandemic-era policies that support interstate coverage and payment parity are key to ensuring its long-term viability and success.
Policy engagement and sustained impact
Ellimoottil uses his expertise as both a researcher and clinician to engage with policy stakeholders and help inform telehealth policy and practice.
In 2018, Ellimoottil established the University of Michigan Telehealth Research Incubator to support policy-relevant research that provides stakeholders with insight into telehealth’s population-level impacts. This work has led to meetings with a variety of stakeholders, including the Michigan Association of Health Plans, Blue Cross Blue Shield of Michigan, and the National Governor’s Association.
During the pandemic, Ellimoottil developed policy briefs on telehealth use in Michigan during COVID-19 and telehealth use by Medicare beneficiaries in 2020 to provide policymakers with swift insight into telehealth’s expansion and use during this period. He also moderated a symposium on virtual care optimization with members of Israel’s telehealth research community, and in 2023 published a comprehensive overview of telehealth’s impact on healthcare access in Michigan in partnership with the Michigan Health Endowment Fund.
As a result of his research and expertise, Ellimoottil was invited to testify before the U.S. Senate Finance Committee’s Subcommittee on Health during the 2023 hearing, “Ensuring Medicare Beneficiary Access: A Path to Telehealth Permanency.” In his testimony, Ellimoottil discussed the potential long-term consequences if pandemic-era policies that ensure ongoing coverage alignment across payers, payment parity, and coverage of audio-only telehealth are not extended.
Ellimoottil has also engaged with numerous federal agencies and other stakeholders to help inform official positions and policies, including the Assistant Secretary for Planning and Evaluation (ASPE), the Health Resources and Services Administration, the Medicare Payment Advisory Commission (MedPAC), the Office of Inspector General, and the National Cancer Institutes. At the state level, he has presented his research to the Michigan Health Policy Forum and the California Telehealth Policy Coalition.
As Medical Director of Telehealth for Michigan Medicine, Ellimoottil helped develop Michigan Medicine’s five-year Strategic Plan for Virtual Care. In addition, his research has been cited in numerous policy documents published by the states of California, Maryland, and Minnesota, as well as the Agency for Healthcare Research and Quality, the American Telemedicine Association, ASPE, MedPAC, the National Academy of Medicine, and more.
Future research
Ellimoottil’s future research will continue to explore telehealth’s changing role in healthcare. This work will focus on costs, usage, and potential barriers to telehealth’s continued use and expansion.
More information about Chad Ellimoottil’s work can be found in his IHPI Profile and in Michigan Experts.