Prior to 2020, Telehealth was an available but rarely accessed option for many Americans. With the promise of improved access to care and increased convenience, large employers began offering employees telemedicine coverage at a steadily rising pace in the years prior to the pandemic. Yet despite 74% of employers offering telehealth by 2018, a 2019 Employer Health Benefits Survey showed only 2.4% of employees took advantage of these services.

Then the pandemic hit, and with it how we access many services, including healthcare. As offices closed, except for emergent care issues, and social distancing became the new mantra, patients needed alternatives for receiving care. Quick action by several agencies, including the U.S. Department of Health and Human Services and the U.S. Drug Enforcement Administration, led to policy changes that encouraged faster adoption of Telehealth.

Subsequently, many states have broadened telehealth, which has led to increased participation, loosened licensing regulations for online prescriptions and better aligned telehealth services with in-person visits. Commercial insurers have responded by curtailing cost sharing as well as expanding coverage and in-network telehealth providers.

These changes not only assisted in telehealth’s meteoric rise amid the Covid-19 crisis but have also revealed how beneficial telehealth can be. Patients and providers alike have utilized telehealth technologies to better serve everyone during a period of unprecedented limitations, including:

• • Patients exhibiting no Covid-19 symptoms who have come in contact with an infected person.
  • Providers under quarantine who are still able to treat patients virtually from home.
  • Chronically ill patients who would rather not risk exposure from an in-person visit.
  • Patients with mild respiratory symptoms who do not warrant a trip to the emergency room.

Telehealth’s sudden availability saw swift results, and by late April 2020, 23% of adults had already taken advantage of telehealth services. As physician offices have since opened up, patients returned to long-term preferences for in-person care. However, there are some specialties, especially Mental Health, where telehealth can serve as a long-term viable option. An American Psychiatric Association poll shows 38% of Americans have used telehealth for medical or mental health services, a 7% increase from a year ago. But telehealth’s acceptance as a preferable option goes beyond those numbers, as nearly 60% of people polled say they would use telehealth for mental health services, and 57% welcome the idea of using an online chat for their mental health needs. Perhaps most encouraging for telehealth’s future is that 43% of adults polled hope to continue telehealth services even after the pandemic is past us.

In order to continue to build momentum and ensure that telehealth remains a viable alternative for patients, several key areas must be addressed.

• Reliable internet access. Not everyone has a consistent internet connection. Rural areas and underprivileged communities are especially at risk, as are healthcare providers who serve these areas. A study by the Harvard School of Public Health determined that as of early 2019, 21% of rural Americans (or their families) reported difficulty accessing high-speed internet. Remedying this situation requires the establishment of comprehensive telecommunication infrastructure.
• Permanent reforms. While enacted through the end of 2021, telehealth coverage from traditional Medicare recipients under the Covid-19 health emergency is up for renewal every 90 days. There is currently no intention to extend these coverage changes after the pandemic. At this time, Centers for Medicare & Medicaid Services have determined that once the pandemic is over, they will no longer cover audio-only evaluation or management telehealth.
• Licensing across states. Telehealth regulations vary state to state. In states that are not participating members of the Interstate Medical Licensure Compact, physicians are restricted to exclusively treating patients who live in the state where they are licensed. The ISLC enables physicians to engage in telehealth services while out of state. However, only 29 states, the District of Columbia and the Territory of Guam, participate in this compact.
• Compensation parity. Current revisions made to payment parity only apply during the pandemic.

Telehealth has proven itself undeniably practical. However, ensuring its long-term survival will require ongoing work and revision, including broadband improvements, permanent Medicare reforms, Interstate Medical Licensure Compact participation and payment parity assurance.

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