Between 2020 and 2022, telehealth visits declined by 46%, dropping from 76.6 million to 41.5 million. However, telebehavioral health services remained popular, constituting 63% of all telehealth visits in 2022. Despite the decline, most users had few virtual visits, and both physicians and patients found video visits inferior to in-person care. Behavioral health emerged as a leading telehealth use, with in-person follow-ups primarily driven by these conditions. Traditional Medicare led in delivering behavioral health services via telehealth, followed by Medicare Advantage, Medicaid, and commercial insurance.
Telehealth visits experienced a notable 46% decrease between 2020 and 2022, with virtual visit volume plummeting from 76.6 million visits in the second quarter of 2020 to 41.5 million visits in the fourth quarter of 2022, as revealed in a recent report by market research firm Trilliant Health.
The report, titled “2023 Trends Shaping the Health Economy,” offers insights into significant trends within the healthcare sector. Data was sourced from a variety of reliable outlets, including Trilliant Health’s comprehensive national all-payer claims dataset, encompassing commercial, Medicare Advantage, traditional Medicare, and Medicaid claims, as well as the firm’s consumer dataset containing psychographic, demographic, social determinants of health, and lifestyle data. It also incorporated financial statements from health systems, health plans, and companies, in addition to data from the Census Bureau, Kaiser Family Foundation, and the Centers for Disease Control and Prevention (CDC).
Interestingly, while the overall volume of telehealth visits declined, telebehavioral health services bucked the trend, accounting for a significant 63% of all telehealth visits in 2022, up from 41.8% in Q1 2020.
Despite the decline in telehealth usage, a majority of users (80.2%) in 2022 had four or fewer virtual visits. Super-utilizers, those participating in 25 or more virtual visits, constituted only 2.5% of telehealth users, primarily consisting of younger individuals with an average age of 34.6 years and a majority being female (65.6%).
The report also highlights that more than half of physicians (61%) and a third of patients (33%) believed that the quality of video visits was worse or much worse than in-person consultations. Only a small fraction, 6% of physicians and 16% of patients, perceived video visits as superior in quality to in-person care.
This perception of lower video visit quality was attributed to concerns related to the inability to conduct physical examinations and technical and communication challenges.
In contrast, behavioral health emerged as a prominent use case for telehealth, with the share of telehealth visits for behavioral health conditions increasing from 41.8% in Q1 2020 to 62.8% in Q4 2022. However, in 2021-2022, in-person follow-up visits were predominantly driven by behavioral health conditions.
Approximately 11.1% of all telehealth visits led to in-person follow-up visits within a week for the same clinical reason. The top three diagnoses requiring such follow-ups were reactions to severe stress and adjustment disorders, recurrent major depressive disorder, and pervasive developmental disorder.
Furthermore, 56.5% of telehealth visits resulted in in-person follow-up within three weeks, primarily attributed to behavioral health diagnoses.
Excluding behavioral health conditions, 16.7% of telehealth visits in 2021-2022 led to in-person follow-up visits within one week, and 29.2% within three weeks. The top diagnoses for these in-person follow-ups, excluding behavioral health, were contact with suspected exposure to communicable disease, encounters for other counseling and medical advice, general examination, and type 2 diabetes.
These findings align with previous reports by Trilliant Health, including the 2022 Trends Shaping the Health Economy Report, which indicated a 37% reduction in telehealth visit volumes from Q2 2020 to Q1 2022. Additionally, virtual behavioral healthcare services consistently saw an increase, growing from 32.4% of all telehealth visits in Q1 2019 to 59.9% in Q1 2022.
Traditional Medicare saw the highest share of behavioral health services delivered via telehealth, increasing from less than 2% in Q1 2019 to 48.6% in Q2 2022. It was followed by Medicare Advantage (40.1%), Medicaid (36.7%), and commercial insurance (31.8%).
