JAMA study finds telemedicine catching on but still relatively rare

The study also found that comprehensive parity state mandates and the lack of psychiatrists were factors in telemedicine usage.
By Laura Lovett
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When it comes to telemedicine, comprehensive reimbursement and coverage state mandates and a dearth of local psychiatrists were key factors in adoption, according to the a research letter about the trends in telemedicine published in JAMA yesterday

The letter, which examines trends of telemedicine uptake in a large commercially-insured population between 2005 and 2017, found that while telemedicine was steadily growing during the time period, the majority of patients were still opting for in-person visits with their provider. 

Authors of the report used data from OptumLabs Data warehouse and zeroed in on privately insured and Medicare Advantage enrollees at a large private US health plan. Researchers broke down the telemedicine visits into three categories: telemental health visits, primary care telehealth visits, and specialty telemedicine visits. 

Researchers found that the bulk of the visits were either telemental health  (53 percent) or primary care (30 percent). 

Overall, the number of patients using telemedicine jumped from 206 in 2005 to 202,374 in 2017 with an average growth rate of 52 percent per year—meaning that less than one per 1,000 members were using the service in 2005 and around 6.5 per 1,000 members were using telemedicine in 2017. 

“Although telemedicine use increased substantially from 2005 to 2017, use was still uncommon by 2017.Use of telemental health grew steadily over this period,” authors wrote. “In contrast, there was a rapid increase in growth for primary care telemedicine in 2016 and 2017 after coverage for direct-to-consumer telemedicine expanded.”

Another key take away was that urban residents accounted for 83.3 percent of the visits between 2015 and 2017. Researchers also looked at the average age and gender in the data from 2015 to 2017, finding that 63 percent of telemedicine users were female and the average age was 38.8 years. 

Importantly, authors noted that the study was limited by the fact that all of the data was from a “single insurer whose population and policies may not generalize to other populations.”

Why it matters

Industry leaders have often posited telemedicine as a solution for reaching folks in rural locations or areas with a shortage of trained professionals. In this study, researchers found that telemedicine uptake did increase where there was a lack of psychiatrists but the availability of primary care doctors did not influence telemedicine usage. 

Additionally, the research showed that a large majority (83 percent) of telehealth users in most recent years were urban residents. That factor is in line with other recent findings. Earlier this month the USDA issued a report that found rural residents were less likely than their urban counterparts to partake in online health research, maintenance and monitoring services. 

The trend

Telemedicine has long been a cornerstone in the digital health world. As more and more name-brand insurers have incorporated telehealth options into their offerings, the federal government has also began to implement telehealth strategies. At this year’s Connected Health Conference in Boston FCC’s Ajit Pai broke down a number of initiatives the FCC is funding or spearheading to help bring broadband and telemedicine services to those rural communities. Many of these initiatives come via the Universal Service Fund, the mechanism by which the FCC subsidizes telecommunications networks.