Telemedicine has evolved from its humble roots as a means of transmitting radiological images over telephone wires to a sophisticated videoconferencing experience for patients. Most recently, the COVID-19 pandemic has contributed to telemedicine usage spiking, as patients sought to avoid hospitals and doctors’ offices. Still, there is scant literature evaluating outcomes for patients using synchronous videoconferencing telemedicine platforms. In a review of current literature on videoconferencing telemedicine as popularly practiced during the COVID-19 pandemic, the Employee Benefit Research Institute (EBRI) examines the factors that could influence wider adoption of telemedicine as well as its effectiveness in affecting patient outcomes. This review finds:
- Evidence that telemedicine can be effective: One state’s telemedicine system contributed to a reduction in 60-day infant mortality rates and has helped adolescent asthmatics better manage their symptoms. Telemedicine can be as effective as in-person visits, at least for certain types of care, such as managing diabetes or allergies.
- Evidence that patients found the telemedicine experience compelling. That is, they found telemedicine platforms easy to use, and enjoyed the convenience and time savings that telemedicine offers.
- Signs that the pandemic has affected usage patterns: One recent study found that since the onset of the pandemic, telemedicine visits increased twenty-three-fold relative to pre-pandemic times.
- Evidence that some benefits executives at large corporations saw telemedicine as a cost-savings tool, although others wondered whether their workers used telemedicine as a substitute for in-person care or for care that would not have been sought in-person.
- Two important questions that EBRI aims to answer in future research. To what extent did telemedicine impact outcomes for patients who pivoted to using it to receive care during the COVID-19 pandemic? And will patients continue to use telemedicine as they have during the pandemic, or will they prefer to return to primarily in-person visits?
Telemedicine is a promising means for health care providers to connect with their patients in a way that is more flexible and cost-effective. Patients do not need to travel to receive health care services, which is a boon to many patients, including the elderly and those in rural areas who may live far away from their health care provider. However, as with futuristic innovations like self-driving cars, realizing the full benefits of telemedicine has long been prognosticated to be “just around the corner.” It is now, however, that a confluence of factors have created conditions in which telemedicine is well-positioned to succeed. Reluctance to visit hospitals and doctors’ offices, lower barriers to technology and increasingly prevalent video communication software, reduced regulatory barriers, and buy-in from employers have finally thrust telemedicine into a prominent role in the United States’ health care system.
Still, the extant literature on the impact of telemedicine on outcomes — in particular, telemedicine visits that substituted in-person visits during the COVID-19 pandemic — remains relatively scant. This is not particularly surprising; telemedicine as practiced and popularized during the COVID-19 pandemic is a relatively new phenomenon. In a review of current literature on telemedicine as practiced during the COVID-19 pandemic, EBRI examines the factors that could influence wider adoption and effectiveness of telemedicine in affecting patient outcomes and reducing health care costs.
pe wider te Ref Nadar, rce Thi ere ntMahm s leme of study n ol ces d d oud, er adults icine w asP ad cond hilo i ppe J ption diuct d no ed ouvet may t have through the , Marisa actually regula iTucci, Bar EB ncreas r acces RI Ce e s to a cos nter ucts h Toled c for for e omResearc pu m ano, a ter, t ployers h hus nd Clau on . p An H rec ealth Ben early st de luding Sicott th uefi de. “ em f y on ts Im Innovat rom th pact o e takin ission ue f Sy f g (oun nchronous E th BRI e d full tCRH hat est BI) on ly 1 , 2 Fi Figure 2 gure 3 Jake Spiegel is a Research Associate at the Employee Benefit Research Institute (EBRI). This Issue Brief was written The Webcam Will See You Now: A Review of Telemedicine with the funding support of the following organizations: Aon Hewitt, Blue Cross Blue Shield Association, advantag Tel perce emnt of edic e ine tel of e t Models on he medici teleme ne Cl vis dicin iits nical e wser ervices Outco e direct m oes in Pe ff substitutes ered by diatric health for in Acute care -pers Car provide on car e Settrs e ing . (As s: A Sy hwood ste 2mat 017ic ). However, Review.” P ted his may not iatric Care be with assistance from the Institute’s research and editorial staffs. Any views expressed in this report are those of the Ashwood, J T Sc elemedic ott, Ateev M Premium ine Visi ehrota, D ts D In avicrease d uring Pande Cowling, an s Am d Lo ong E mic ri Uscher Re mployers -lat Pinive t es. “Dir oW Pre ect it-h 10 or to--Pa Cons ndemic, by umer Tele More health Week May In crease During the COVID-19 Era ICUBA, JP Morgan Chase, Pfizer, and PhRMA. represe Medicine. Dec ntativeember of the 201 care so 8. ught during the pandemic and may not be representative of future care if the pandemic author a Access to Care nd should , Bu t not Does be Not ascribe Decr d eas to the e S o pe ffnd icers ing.” Healt , trusteehs Af , or other fairs. March sponso 20rs 17 of . EBRI, Employee Benefit Research Employees, Worker Earnings, and Inflation, 1988 –2019 An estimate of telemedicine preparedness among older adults in the United States found that 13 million people may By Jake Spiegel, Employee Benefit Research Institute has actually changed 14% patients’ telemedicine habits. Institute-Education and Research Fund (EBRI-ERF), or their staffs. Neither EBRI nor EBRI-ERF lobbies or takes positions Figure 1 April 1, 2021 • No. 528 have Mehrota difficul , Ate ty e v, Michael taking full Che advantage rnew, D of avi tel d Li emedici netskyne , Hilary services Hat (Lam ch, Davi et a d Cutler, a l. 2020). nd Er The e ic C lderl Sc y (adul hneider. ts older “The than Imp 85) act of , older Barnett, Michael, Kristin Ray, Jeff Souza. “Trends in Telemedicine Use in a Large Commercially Insured Population,” on specific policy proposals. EBRI invites comment on this research. Pre Visit mium s t Inco reas Ambulatory P e Worker Earni roviders, ngs Increas Re es lative to Ove rall Inflation COVID As adu a lts res without -19 on ult, employers Outpatie a hig 12% h schoo nt in E ViBRI’s stu sl dip its in 20 loma, dy 20 and : teVi nd solder its ed R to emaine ad be u ca lts i utiously d Stable, n the low op D est tim es i pi is nc ttic e om a Lat about e qe uin tel Surge tilee were medici in Cas d ne’ is es. s propo fut ” Co ure, rtionat mm ev onwealt en ely asill t-h Fun hey ke equippe d. pt d 2005-2017. JAMA. 2018. 20% 18.6% A Brief History of Telemedic Pre-Pa ine ndemi c Levels, by Week Number to tak expect 2021. e ations advant about age ousa f teleme ge in di a p cin os e tof -pan feride ngs mic worl . Thesed in barr ciheck. ers to access While te were lemed ow icine ed mi to gh either t be i a ne n ap xperi pealing ence with repl tec acement for hnology The Webcam Will See You Now: A Review of Telemedicine Suggested citation: Spiegel, Jake, “The Webcam Will See You Now: A Review of Telemedicine During the COVID-19 16.7% 18% 10% 17.1% Bashshur, Rashid L, Timothy G Reardon, and Gary W Shannon. “Telemedicine: A New Health Care Delivery System.” or d The focus in-pers isab on ilities o heal f t this p th care hat make ape when r i com s on patien tel munication emts ed are s icine deekin i fas ficul it has com g t. A to m nother inim e to be und study ize contact examin ers with too ingd t M he in ed the oica uts con re ide b text of eneficiaries world, i th t re e CO mains esVID timat to -19 pa ed be t se hat nde en 4mic 1 . care through a telemedicine program were less likely to be admitted to the emergency department (Ho et al. 2014). Era,” EBRI Issue Brief, no. 528 (April 1, 2021). During the COVID-19 Era Patel, Sadiq Y, Ateev Mehrota, Haiden A Huskamp, Lori Uscher-Pines, Ishani Ganguli, and Michael Lawrence Barnett. 20% 14.7% Annual 16% Review of Public Health. 2000. T whe pe he rce scope thnt er th did ie n s t h ohere abi t own tsfor w a e ork com limite ersp formed uter or d to telem l durin apto edp with a g ic the ine de pan fin broad de ed mic as band w the ill co carry synchro nnect ove ion, and an nous r after provis it su a ion bsi dd iof de tional s he . Als alth 41 o, em care percpl ent and oyers di servi d n wil ot o ces l no v w d n ia ou a bt Similarly, evaluations of telemedicine consultations for children in rural emergency departments and acute care settings 8% “Variation in Telemedicine Use and Outpatient Care During the COVID-19 Pandemic in the United States.” HealthAffairs. By Jake Spiegel, Employee Benefit Research Institute s keep videocon mart a ph clos one fere e ey w ncing pl ith e on a data wh atforms ether plan tel (Roberts whic em h ed aric e a ine en nd abl vis Mehrota eits d by h actuall 20 igh 2 y -0 sde )pe . While creas ed broa e t the hese db and health two st intern care udies et. co f Ho s ots cus wever, incurre ed on it i d b ol s de useful y their r Americans to sum workermarize ,s the , and y Copyright I 14% nformation: This report is copyrighted by the Employee Benefit Research Institute (EBRI). You may copy, found evidenc10% e for improved mortality rates and higher quality of care (Dharmar et al. 2013 and Nadar et al. 2018). 12.1% Bashshur, Rashid, Gary Shannon, and Hasan Sapci. “Telemedicine Evaluation.” Telemedicine and e-Health. 2005. 2021. wil the illust l act accor hrate so umble me be ding gi of nni t ly to he ng p s s o truct rom f tel o uemedi tral i e or mp elimina ced ineimen so t tets h tel at w to w em e ed ide ca icr nine adoption o be from tter un the de f suite te rstan lemedici of d its tools ne. evolution the y use to ma over time nag ane d conce health ptualize care cos the ts. print, or download th 6% is report solely for personal and noncommercial use, provided that all hard copies retain any and 11.2% While 12% more study of different medical specialties is needed, these studies provide some encouraging evidence that 0% 10.1% 10.1% A T A G L A N C E role it could play in the future. all copyright and other applicable notices contained therein, and you may cite or quote small portions of the report telemedicine can improve patient outcomes. Borries, Trevor M, Ashley Dunbar, Arti Bhuken, Joshua Rismany, Jessica Kilham, Richard Feinn, and Thomas P Meehan 10% 1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51 Portnoy, Jay, Morgan Waller, Stephen De Lurgio, Chitra Dinakar. “Telemedicine Is as Effective as in-person Visits for In addition to the geographic and socioeconomic 8.1% barriers to telemedicine adoption, there are also regulatory barriers. 4% -10% provided that you do so verbatim and with proper citation. Any use beyond the scope of the foregoing requires EBRI’s 8.0% 7.3% 7.5% Sr. “The impact of telemedicine on patient self-management processes and clinical outcomes for patients with Types I Patients with Asthma.” Annals of Allergy and Immunology. 2016. 6.9% 8% 6.1% 6.3% An e C Until rec onclusio arly p ently, apern Medi op erat carionali e offer zeed s tel reimb emedi urs cin ement for e as a sys tel tem i emedici n which ne s p ervi atices ents i e n limite ngaged circum in remot stances e commu , such as nication for with patients health 6.1% 6.1% Another study examining rural asthma patients found that telemedicine visits were not inferior compared with in-person prior express permission. For permissions, please contact EBRI at permissions@ebri.org. 6.1% Telemedicine has evolved from its humble roots as a means of tra 6.1% nsmitting radi 5.5% ological images over telephone wires to or II Diabetes Mellitus in the United States: A scoping review.” Diabetes & Metabolic Syndrome: Clinical Research & -20% 2% 1 care in design provide ated rs rural using arin eas forma . However, tion technolog the CMS y (Bas expan hshur et ded acc al.ess 20 f 0or M 0). In edi deed care , the bene imp ficiet aries us of develo in Marchping 2020 by teleme prov dici idi ne ng 6% Tel visits em in edh ic elp ine in has evolv g patients m ed fa rnag om u e the tilizin ir ast g ruhma dimentary (Portnoy anaet al log tec . 2016). hnolo gy Furthermo to a richre, synchro patients nous vi in the de s otudy who rec conferencing eived 4.1% Roberts a sophisticat , Erice T d , vi an de d oco Atenev ferMehrota encing e. xperie “Assess nce for ment of patien Disparities in D ts. Most recentl igital Acc y, the ess CO A VID mo -ng 19 M pan edde icar 3.9% mic e Be has contr neficiariies a butend d to 3.6% Reviews. 2019. 3.8% 2 capab waivers ilities for he waalth s for te care prov lemedic ide ine rs and r to act as eim an burs eff ing pr ective su oviders bstitut for t e for elem in e-di pe cin rse on ca visits re (B at the ashshur et same rat ale. as i 200n 5). -p erson 3.0% visits. Report avail -30% ability: This report is availa 2.5% ble on the internet at www.ebri.org platform. No longer limited by technology to radiological images transmitted over telephone wires, patients 2.6% can more care via telemedicine were asked to rate their experiences. Most patients agreed that the telemedicine platform was 4% 2.4% Implications for Teleme 0% dicine.” JAMA Internal Medicine. 2020. telemedicine usage spiking, as p 2.1% atients sought to avoid hospitals and doctors’ offices. Still, th 2.1% ere is scant literature 3 Techn This waiver ologica wl innovat ill be in e ions o ffect funtil ten mo the en ve at d a of breakne the public h ck paecalth e, and te emerg leme encdi y.cin As e such is no e , itx r ception. emains to In th bee spast een wh few dec etherades, this eas naturally y to use, inter aact wit ppreciate h th d eir doct the abilor in ity to rea inter l time act wit usin h g an vid deoconfer ask quest enci ions ng platforms of their doctor . Boos s, and ted by res con ponded cerns t ab hat th out th e e risk 1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51 Brook, Robert H, John E Ware Jr, William H Rogers, Emmett B Keeler, Allyson R Davies, Cathy A Sherbourne, George A evaluatin 2%g outcomes for patients using synchronous videoconferencing telemedicine platforms. In a review of current -40% barrier the teleme to rdi ece cine iving land care sca thro pe has alrea ugh telem dy ed sh icifted cons ine has be ide enr perma ably. Perha nentps ly lo the were first d. implementation of telemedicine occurred of infection, telemedicine visits dramatically increased since March 2020, offsetting some of the large decline in in- Sofat, R telemedieecha. cine app “Coll ointm ateral ents Effec were t of as g COV ooId as D-19 in o -n peStro rson ke vi Ev sits aluation . Another s in the tudy f Unit oed un Stat d this es. whe ” Nn ew e En xami gla nin nd g Jo satis urnal facti of on f or Goldberg, Kathleen N Lohr, Patricia Camp, and Joseph P Newhouse. “The Effect of Coinsurance on the Health of 0.2% literature on videoconferencing telemedicine as popularly practiced during the COVID-19 pandemic, the Employee 0% Virtual Virtual visi Visits ts as percen as Perce t of ntag tota e of l basel Tot ine al B visits aseline Visits in 1948, when -50% two hospitals in Pennsylvania transmitted radiological images over telephone wires (Zundel 1996). In Table of Contents pe aller Medi rsgy on cine p health ati Lett ent e s care visit rs u . 2 sing a 020.s te . lemedicine platform (Weibel 2016). Adults.” RAND. 1984. Benefit Research Institute (EBRI) examines the factors that could influence wider adoption of telemedici ne as well as its Finally, not all types of care are well-suited for telemedicine. Telemedicine is well-suited to handle consultations, for -1.1% -2% 1967, Massachusetts General Hospital linked with the medical station at Boston’s Logan International Airport using A Brief History of Telemedicine ............................................................................................................................... 4 -60% effectiveness in affecting patient outcomes. This review finds: example. Telemedicine is also well-positioned to enable doctors to remotely monitor patients via devices that transmit Still, there remain some structural barriers that will affect the further development of telemedicine. Though internet The rise i micro The ef Spiege wave fective l, Jake n relay vis n , iess ts and w s of to allow as Paul aai tel F dero em d doc nin s ed tin. tor part icine plat s“ to Fu bytur remo efe for for otely m relative f tsHealt to int lowe h eract Br re to ene w ig fn ith its ulatory -p i ers p n atients th on visits b e a W rrier ork an i d s pl s to tel con i ace: mport du Employ em ctant, p ed riic mary bu iers ne t so . On ’ care and Pers too March pe is ctiv p e atient satis es Duri 17 mer 2020, short gency ng the fact services ion. ly -4% Burns, Pat. “Telehealth or Telehype? Some Observations and Thoughts on the Current Status and Future of Structural Impediments to Wider Adoption .............................................................................................................. 4 data through the internet, like blood pressure monitors or glucose monitors. But diagnostic tests that require specialized -70% An e pe COVID netr ffectiv ation -19 Cris e ra sys tes is. tem is un ” h EBRI ave Iss incre likely to ue asBri edef ,be an n w o. d e m 517 ll- or utili e (Em p ze eopl d if ploy e its e ar e end us e Btenefit R oting ers smart are esear frus pho ch nes wi trat Insted itute, t h dat by t2he 0a p 20 e) xperie la . ns, older nce, af and ter poorer all. A s pe ystemat ople ic be (Bas for hshur et e states a be l. g 2005) in iss.ui The ng lsock e sdown re ystems did ques not widely ts, the W p hit ro e lif Ho erat use e beyo annon unced an d their initial effor a t to e pplicxp ations and ac tha ces nks s to tel to a le ack he o alth f in Telehealth.” Journal of Healthcare Information Management. 1999. • Evidence that telemedicine can be effective: One state’s telemedicine system contributed to a reduction in 60- Tel equi em pment edicine lik in the e radiologi Timcal e of CO scans VID cannot -19 ................................ be performed using a tel ................................ emedicine platfor................................ m, nor can procedures .................... like 5 may not be able to access the synchronous telemedicine platforms that many have become familiar with during the review governme the face o of p nt fundi f ati the ent COVI e ng xperie , Dbu -19 p tn th ces with and ey d em id es ic. tel tablis T eme he CM di h cin the S an e feas in no diunc cat ibilit e ed y of s that a waiv tep leatients me er t di hci at ten ne ex sde pan ysd tems to ded be . the satis con fie did with tions und the er car which e they Medicare Typical Year 2020 day infant mortality rates and has helped adolescent asthmatics better manage their symptoms. Telemedicine Source: Mercer, National Survey of Employer-Sponsored Health Plans, and Bureau of Labor outpatie Waibel, Ki nt sur rk Hge . “ries Sync . W hronou hile ts eleme Telehealt dicine h c for Outpat an be a uient seful Allerg way to y Consul determine whet tations.” An her an in nals of Allergy, A -person visit is nec sthma, an ess d ary, it Dharmar, Madan, Patrick S Romano, Nathan Kuppermann, Thomas Nesbitt, Stacey L Cole, Emily R Andrada, Cheryl receive pandemic. d thro Als uo, reg gh teleme ulatory dici barriers t ne (Kruse et hat al had . 2017 limited ). Of rei th mbursem e 44 studi ent es e for h xamined ealth car , a plu e prov rality iders fou to nd tha designate t patients d rura prl ef zon erred es would reimburse health care providers for care delivered via telemedicine. The waiver aimed to foster adoption of But Does It Work? ................................................................................................................................................. 7 can be as effective as in-person visits, at least for certain types of care, such as managing diabetes or allergies. Immunology 116. 2016. Tel cannot act emedicine as has not a substitute been without for all type its s n oa f ys inayers -person car . Indee e. d , some prognosticators have taken a dim view of telemedicine, Vance, Danielle Harvey, and James P Marcin. “Impact of Critical Care Telemedicine Consultations on Children in Rural have been lowered, and many private insurers similarly made it easier for patients to seek care via telemedicine, but it teleme using tdi elem cine ed aind cine ena ovbl er i ed n- m pore erson visits patients to , believe safeld y treceiv elemeedi care cine while si offeredmultaneous an improved ly c help ommunication ing to reduce expe the rience, sprea d or of • EvidenceSo that urce patien : Ateets v Meh founrotra e d the tel t alem ., The edic Impa ine ex ct pe of rie COVID nce compe -19 on lli Outpa ng. T tien hat i t Visi s, th ts in 2 ey fo 020: Visits und telemedicine And What Do Employers Think? .............................................................................................................................. 8 questioning its ability to be a cost-saving te 7 chnology and instead considering telemedicine to be another cost burden Emergency Departments,” Critical Care Medicine. Volume 41 Issue 10. 2013. found tel is unclear eme whe dther th icine plat ese forms polic e ies will asy to pe use rs.is t in It should a pos be t-pan no de ted mic that th world. ese Should these studies wer e c regondu ulatory cte b d pre arriers b -pane de re mic instit , an uted, d so A series COVID-19. of interviews conducted by EBRI with health benefits executives shed some light on corporate attitudes toward Remained Stable, Despite a Late Surge in Cases (Commonwealth Fund, Feb. 2021). platforms easy to use, and enjoyed the convenience and time savings that telemedicine offers. Som Zunde e l, of KM. the “bTel arriers emed tel iceme ine: di His cin tor e y, App faces to lic w ations ider, and Im adoption pact on are not Lib insu rari rmo anship. untable, h ” Bullet owever. in of the Broad Medic ban al d Libra internet ry Conclusion for health care ................................ providers to shoulder ................................ (Burns 1999). Offic ................................ es must adapt to new ................................ workflows to accommo .......................... date telemedicine 10 patients may be nudged back toward in-person visits. patients’ perceptions of https:// satis doi.org faction /10.26were 099/bvh noft affect -e411 ed by the fact that telemedicine was the only way they could receive telemedicine. In general, the health benefits executives interviewed expressed positive opinions of telemedicine and • Signs that the pandemic has affected usage patterns: One recent study found that since the onset of the Association. 1996. penetration continues to increase, as do smartphones with data plans. Additional policy proscriptions, such as using Fronstin, Paul, and M. Christopher Roebuck. “Managing Use of Health Care Services After People Satisfy Their pl Tel atform emeds ic , ine whic vis h its coul were d req alu so in ire additio centivize nal d by i trainin nsura g. Ad nce di pro tionally, viders th ere a at the re l outset of icensing th an e pand d privacy emic ch . A all eteng na, a healt es. Teleme h dicine care. Still, positive patient experiences can go a long way toward cementing future telemedicine habits. expressed optimism about the role it might play in a post-pandemic world (Spiegel and Fronstin 2020). Several References .......................................................................................................................................................... 11 pandemic, telemedicine visits increased twenty-three-fold relative to pre-pandemic times. Medicare funds to subsidize or pay for telecommunications equipment that can only be used for telemedicine visits Deductible: What do Copayments and Coinsurance Do?” EBRI Issue Brief no. 519 (Employee Benefit Research Institute, Though hardly numerous, there are evaluations that demonstrate telemedicine can be a viable replacement for in- providers insurance f lice irm n, i sed nst in itute one d s ata policy te may not to reimb neurs cese sarily b all hea elth al care lowed p to rovpe ide rform cons rs for care deli ultatio vered ns acros via s te stat lemedici e lines ne . An at th d h e ealth same interviewees noticed large upticks in usage since the pandemic started, with one interviewee lamenting that their firm’s • Evidence that some benefits executives at large corporations saw telemedicine as a cost-savings tool, although Endnotes ............................................................................................................................................................ 12 could also reduce barriers to telem 5 edicine. Furthermore, while older patients may struggle with the technological savvy 2020). person visits, at least for certain types of care. Moreover, patients tended to respond positively to the telemedicine care ratesprovide as carers de must liver ed ado in pt n pers ew proto on. Anth cols em similarly to ensure patie waived nt cost data issha co rin nfg idfor enti tel al eme and dic transm ine vis itted and its during sto the firs red sec t 9 ure 0 d lyays . telemedicine offering had been, up until the onset of the pandemic, an underutilized resource. Additionally, some Endnotes others wondered whether their workers used telemedicine as a substitute for in-person care or for care that to navigate telemedicine platforms, younger patients are less likely to have such qualms. Additionally, given sufficient experience, highlighting its ease of use. Additionally, some patients also responded positively to decreased waiting of And the pand Wha em t ic, as did Do Emplo many membe yers Thin rs ofk? the Blue Cross Blue Shield Association. Furthermore, in a bid to encourage interviewees were enticed by the possibility of realizing significant cost savings from their workers shifting care from in- would not have been sought in-person. Fronstin, Paul, M. Christopher Roebu ck, Jason Buxbaum, and A Mark Fendrick, “Do People Choose Wisely After mo Increas tivatin iog dig n, poilicymak tization, a erslong and i with nsur hi ance ghe co r inmpanie ternet s pe coul netra d make tion rates perman , ushent ered th in e prov a new isi ons era of that tel tem emed porar icine ily pl dism atforms antled . times as well as eliminating the need to travel. patients to seek care via telemedicine, the Coronavirus Aid, Relief, and Economic Security (CARES) Act contained Employers can play a pivotal role in fostering even wider adoption of telemedicine. They are uniquely well-positioned to person urgent care and emergency departments to virtual telemedicine visits. One interviewee estimated that an 1 • Two important questions that EBRI aims to answer in future research. To what extent did telemedicine impact Figures Satis See fying Hea https:// ww lth w. Pla cms n Ded .gov/n ucewsro tibles? om/ Evi fade ct-nshe ce F ets/medic rom theare Us-e telemedi of Lowci -Val ne-ue hea Hea lth-lth care C-ar provi e Servi der-ces fact,-” shee EBRI t Issue Brief no. th Ase ynchro regulato nous ry barri “store ers -an to d-wi sede ndr t ” metho elemed ds ici , ne pop aul dop arize tiod d n. uring the 1990s, became a popular way for doctors to consult 6 provisions that allowed high-deductible plans to cover expenses prior to the patient meeting their plan’s deductible. While care sought at hospitals rebounded after stay-at-home orders were lifted, researchers have documented a promote telemedicine usage, since they can incentivize their employees to use telemedicine services. They can, for employee seeking care via telemedicine would save their company between $120 and $800 per visit, depending on outcomes for patients who pivoted to using it to receive care during the COVID-19 pandemic? And will patients 516 (Employee Benefit Research Institute, 2020). Finally, employer buy-in may be critical for more widespread adoption of telemedicine. Employers can implement with 2 their patients. In this method, patients upload the information necessary — such as x-rays, lab results, and so on Ibid “d Fig eure 1, ficit” oVi f h sit ealth s to Ambu care vis lato itsry Prov relative iders to pr , Relative e-pandem to ic Prle e- vels Pan.de Outpati mic Lev ent visits els, by h Wave eek recov Number ere ................................ d from their lows in March ....... 5 instance, make telemedicine visits free (or alternatively, employers can institute disincentives for visiting urgent care or whether the telemedicine visit acted as a substitute for an office visit or an emergency department visit, potentially continue to use telemedicine as they have during the pandemic, or will they prefer to return to primarily in- incentives for their workers to seek out care via telemedicine, or disincentives to nudge them away from high-cost in- — for a doctor to make their recommendations. Asynchronous methods therefore do not rely on face-to-face but were still 8 percentage points lower than outpatient visits during a typical year (Mehrota et al. 2021). Many visits emerg 3 ency departments by making those visits more expensive). Furthermore, since health care cost increases have s Ho aving , Yi-Lw their un, co Jiun mpany n -Yu Yu, early Yen $1 -Hun mig llion Lin, an Yinnuall -Hsy. ien S Ch everal en, interv Chingie -Cwees a hang H lsuang o highlig , Tsehted -Pin the Hsu, be Pao nef-its Yu o Ch f d ua eliver ng, ing m Chie-She ental ng National emergencies can be declared using the National Emergencies Act of 1976 and/or the Robert T. Stafford Disaster Figure 2, Telemedicine Visits During Pandemic Relative to Pre-Pandemic, by Week .................................................... 6 Telemed persion visits cine in the ? Time of COVID-19 person care. Previous work has shown that copayments and coinsurance can be tools that affect the types of care that But communicatio Does I ns, t W butork? they do allow doctors to review patients’ medical records on their own time as their workflow for types of specialty care, as of December 2020, are still lower than their pre-pandemic levels, such as pulmonology outpaced general inflation for decades, as shown below in Figure 3, employers are constantly seeking to innovate and health care via telemedicine as well as consultations steering their workers away from unnecessary care. Hung, and Relief and Eme Ming rgen -Fong Ch cy Assista en. “As nce Act o sessment of f 1988. Bthe oth a Cost cts w -Ef ere u fectiv sed to de eness and clare a Clin na ical tio Ou natco l emergency mes of a F on o Ma urth rch 13, 202 -Generation 0. As of patien The COVI ts se Dek -19 pan , and de employ mic her as s p may w layed a sig ish to niimple ficant r me ole in nt theasdvancin e strateg g ites elefmedici or telem ne. edIic ndeed, ine as m wel any l (Fro patnst ients have in and Ro put ebu of ck f or dictates. In the 1990s, telemedicine typically referred to patients talking to doctors over the telephone. This method For all th Figure 3, e pro Premium Incr mise of telem eases Amo edicine, ng Em there pl have oyers With been pre 10 or cious Mor fe ew Em rig pl ooy rous ees, Wo evaluatio rker Earni ns of patie ngs, a nts nd ’ e Ix nfl pe atio riences n, and visits (down 11 percent), behavioral health visits (down 10 percent), and cardiology visits (down 6 percent). Thus, at find ways to blunt those cost increases (Spiegel and Fronstin 2020). It stands to reason that telemedicine — if it proves Telemedicine is a promising means for health care providers to connect with their patients in a way that is more flexible Synchrono this writing,us thTel e en ehealth d date P of t rohe n gram atio for th nal em e M ergen anage cy h ment as not been of Chronic announ Cardiced. ovas cular Disease.” Journal of Medical Internet avo 202id 0)ed . in-person health care as a result of the pandemic. In particular, many states in the United States imposed allowed patients to describe symptoms with their health care providers and to get a determination as to whether an in- outcomes19 . Sev 88– eral 201s9 tu ................................ dies have examined t................................ he effectiveness of tel................................ emedicine in helping p ................................ atients to manage chr .............. onic 8 least Still, som theree icar s reas e has on to t not emp been erad exp dress ectat edion during the s. Telemed pa ic nin de e mic. visits were incentivized during the COVID-19 pandemic by to be an effective cost-saving tool — could play a role in helping employers who are seeking to manage health care and cost-effective. Patients do not need to travel to receive health care services, which is a boon to many patients, Research. 2014. 4 lockdowns in early April, resulting in the closure of restaurants, schools, and businesses, as well as the postponement pe Srs ee on visit https:// w ww ould w. washingto be necess npost. ary. com/politics/surge-in-virus-hospitalizations-strains-hospitals-in-several- asthma and allergies. In this paper, we focus on evaluations of patient outcomes of synchronous videoconferencing some employers. For example, several employers interviewed in EBRI’s study indicated that they had either reduced or costs. including the elderly and those in rural areas who may live far away from their health care provider. However, as with But two important and intertwined questions remain unanswered and await further research. To what extent has of states/2020/07/08/12855 all non-essential medie5e cal -cc135 are. In -11ea dee -864 d, ealective -0dd31b proce 9d69d 17_story.html ures have bee n halted several times in many states in an effort While some patients delayed seeking care (or did not seek care at all), others did end up seeking care from health care telemedicine platforms. Using Google Scholar, we identified seven accessible papers that fit this criterion. elimin Jeffrey, at Molly, ed costG sail harin D’O g nofrio, for their employe Hyung Paek, es w Timothy ho werF e P slat eeking ts-Mills, Willia care via tm E Soares elemedicine. III Em , Jaso ploy n ers A Ho mip gh pe t , Nicho not conti las nG ue enes, futuristic innovations like self-driving cars, realizing the full benefits of telemedicine has long been prognosticated to be telemedicine impacted the health of patients who pivoted to using it during the 4 pandemic? There exist some data on However, advances in processing power and broadband internet connectivity have led to the development of to ease the strain put on hospitals amid spikes in COVID-19 caseloads. providers via telemedicine. One recent study found that telemedicine visits increased 23-fold relative to pre-pandemic 5 these policies indefinitely, which could affect how their workers seek care in the future. Furthermore, several benefits Bid See isha https:// Nath, ww and w. E ah dw ip.ar org/health d R Melni -insurance ck. “Trend -provi s in Emer ders-resp gency De ond-topartme -coronavirus nt Visits -covid and H -19/ os pital Admissions in Health Care “just around the corner.” It is now, however, that a confluence of factors have created conditions in which telemedicine telemedicine usage during the COVID-19 pandemic, but at the time of this writing, there have been no evaluations on telemedicine platforms that have made patients’ experiences much richer. Instead of conferring with a doctor over the Arkansas’ system highlights telemedicine’s potential to improve health outcomes. One systematic review examined times (Patel et al. 2021). The study, which examined a database of commercially insured patients and Medicare execut Systems ives in sha 5 Stat red es in a perce thepti Firs on that t Months the of m ark the et str COVID uctur -19 e Pandem for telemed ic in icine the US. servic ” JAM es A could Internal shift in t Medi hce ine. 20 near fut 20ure . . In is well 6 -positioned to succeed. Reluctance to visit hospitals and doctors’ offices, lower barriers to technology and Ho patien wever, t t outco he pandem mes. Andic to w also hat e create xtent d a w situ ill pati ation i ents n which continue patien to u ts s ewho telemedi needed cine me indi ac p al os care t-pan put de mi offc w visiting orld? h Oos n pi one tals ph Sone ee https:// or tran ww smitt w.irs ing .go ph v/ne otowsro grapom hs over a /irs-out lidi nes al--up chan int ges erne -tot connect -health-care ion, -spend patien ing ts- av can aila in ble teract -under with t -care he s-ir act doctor s in real patien t outcomes across several different telemedicine platforms and medical specialties (Lowery et al. 2014). Started Advantage enrollees, found that telemedicine accounted for over 30 percent of all visits during the early stages of the particular, they noted that third-party telemedicine consultations are significantly cheaper than in-person consultations increasingly prevalent video communication software, reduced regulatory barriers, and buy-in from employers have and hand doctor , there s’ eoxff ist ices s e viden for fear ce tof hat p contr atacti ients t ng eCOVID nded to -19 b. eAs sat a result, isfied withos h th pit eials s r tele aw few medicine er p e ati xpe ents riences, enter the and t ir d heir oor hea s se lteking h time. This gives the patient a more natural experience akin to face-to-face interaction. These synchronous video in 7 2003 with the goal of improving the state’s poor track record on maternal health outcomes, the system grew over Krus pande, Cl emic em and en s de Scott, monst Nicole rates that Krows teleme ki, Blan dicca Rod ine substitut riguez, e d Lan T for at leas ran, Jack t som elin e eportio Vela, a n n od f in Matt -pers hew on car Brook e. sAd . “di Telehea tionallylth , the It should be noted that this review also found that the plurality of studies (though not all) found evidence of improved and telemedicine consultations through their own doctor’s telemedicine platform, a discrepancy that they thought would finally thrust telemedicine into a prominent role in the United States’ health care system. care outco . mes A cro are ss- sge ectional a nerally com nalys parab is found le totha in-t acros person visits s five stat . Hoes, wever visits , pati to ents emerg may ency prefer a departments return to fell in be -ptw ers een on visits 42 percent after communication platforms have become how many conceptualize telemedicine. the years to serve other populations and focus on other medical areas, such as colposcopies, cardiology, mental health, and shift to Patie teleme nt Sadi tiscin faction: A e has per Sys sist temat ed beyo ic Revi nd ew the a initial nd N l arrat ockdown ord ive Analys ers is.. ” A BMJ Op s of Dec en. 20 ember 202 17. 0, telemedicine visits were outcomes as well. be unsustainable in the longer term. Indeed, more patients seeking care via telemedicine could push costs higher, the and conc 64 plusion ercen of t at th the pan e onsde etmic of the . And pand it re em mains ic, an to d be anot se he en wheth r analyser t is fo hun e re d gu vislatory its to am barriers bulatory that c we are re tem providers porarily wer torn e pediatric asthma, and HIV/AIDS. The telemedicine system contributed to a reduction seen in the state’s 60-day infant more than 8 percent higher than pre-pandemic levels, as shown in Figure 2, although some of this can be attributed to Still, the extant literature on the impact of telemedicine on outcomes — in particular, telemedicine visits that substituted which could, in turn, reduce utilization in the future. nearly down on 60 pe acco rcunt ent of lo t wer he i pan n Ap de ril 20 mic w 20 than ill be erec prete -pd and agai emic n in levels, a pos tas -pan sho demic wn in world. Figure In 1 the (Jeff course o rey et alf co . 2020 nducti and ng thi Mehrota s Lam, Kenneth, Amy D Lu, Ying Shi. “Assessing Telemedicine Unreadiness Among Older Adults in the United States mortality rates and has helped adolescent asthmatics better manage their symptoms. the fact that some doctors have not yet reopened their practices and are only seeing patients remotely (Mehrota et al. in-person visits during the COVID-19 pandemic — remains relatively scant. This is not particularly surprising; Structural Impediments to Wider Adoption et al review, . 2021 EBRI ). A has nother a worke nalys d to b is ui foun ld ad tthat elem ho eds ici pine tals c e laims valu data ated 39 base perce that nt wilfe l e wer nabl pat e an ients empirica for acute l an al ischemic ysis of the stro imp kes act in During the COVID-19 Pandemic” JAMA Internal Medicine. 2020. EBRI Issue Brief is registered in the U.S. Patent and Trademark Office. ISSN: 0887 -137X/90 0887 -137X/90 $ .50+.50 Several benefits executives also wondered whether telemedicine could truly save money. For example, they questioned 20 21). telemedicine as practiced and popularized during the COVID-19 pandemic is a relatively new phenomenon. In a review Indeed, t late Marc teleme While tdi eleme cin elem h 2 e 0d h 20 ed icine ad com ici on ne h p as pare cat an be e ients vo d lv with as effectiv d edur from its late ing the Febr e p hu a uary 2 asmble be nd inem -pe 02 ic rs 0 , and on vis gi (n So nin fat 202 we its gs to a , at antici 0) least much . pate further Th ifor s comes r certain icher ex contri as l typ peitt ries b e le uting to th n of s ce f urcare prise, as or p . at A st is i ients mporta u pdy atients an examini d h nt liter e have alth ng ature. care whether patients were seeking care for an issue via telemedicine that they might not have sought care for in person. of current literature on telemedicine as practiced during the COVID-19 pandemic, EBRI examines the factors that could © 2021, Employee Benefit Research Institute -Education and Research Fund. All rights reserved. Lowery, Curtis L, Janet M Bronstein, Tina L Benton, and David A Fletcher. “Distributing Medical Expertise: The Evolution com providers outco mo mes nly al f s or ike trugg di , t ab here led etes with are patie som differ nts e en using bar tiatin riers tel g to ehmedici ig more h-vane platf lue wides nec pr e orm ead ado ssary s f care oun ption. So d fro evid m low enc me st e -value toudies sug e ge l ective have h st that car ig tel he lig e (medici ht Bred ook di e ne had fficu t al.lties 1 984 a pos an itive d This would imply telemedicine visits are additive and expand demand for health care services rather than acting as influence wider adoption and effectiveness of telemedicine in affecting patient outcomes and reducing health care and Impact of Telemedicine in Arkansas” Health Affairs 2014. s Fronst impact o urrounding in n et al pati a . cces ents 202s 0 ’ to tel ). abi lities em ted o self icine -mana servige ces the , wir hich HbA can 1c s levels low its (Borries adoptio et al n by. p 2019). atients A n and eval hamp uation er i of ts p a t otentia elemed lly icine substitutes for in-person care. If telemedicine visits indeed represent additional demand for health care services, then costs. be platform neficia i l n e T ffe aict on wan tpublic h hat exaealth. mined outco An eval m uation es for by patie thnts e C w enter ith f car or M diov edi ascare cular dis and Me easdi e cai found that d Studies tho (CMS) se who found rece tiv hat ed3 0 ebri.org ebri.org ebri.org ebri.org ebri.org ebri.org ebri.org ebri.org ebri.org ebri.org ebri.org Is Is Is Is Is Is Is Is Is Is Iss s s s s s s s s s sue B ue B ue B ue B ue B ue B ue B ue B ue B ue B ue Bri ri ri ri ri ri ri ri ri ri rief ef ef ef ef ef ef ef ef ef ef • • • • • • • • • • • Apri Apri Apri Apri Apri Apri Apri Apri Apri Apri Aprilllllllllll 1 1 1 1 1 1 1 1 1 1 1, 2021 • , 2021 • , 2021 • , 2021 • , 2021 • , 2021 • , 2021 • , 2021 • , 2021 • , 2021 • , 2021 • No. 528 No. 528 No. 528 No. 528 No. 528 No. 528 No. 528 No. 528 No. 528 No. 528 No. 528 11 12 10 6 9 4 7 3 2 8 5