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Patients Continue to Access Behavioral Health Providers the Most

The Center for Improving Value in Health Care (CIVHC), using data from the Colorado All Payer Claims Database (CO APCD), released its third update to the Telehealth Services Utilization analysis. The new data now encompasses five months of the COVID-19 pandemic (March-July 2020), and shows use of telehealth services nearly doubling in April 2020 compared to pre-pandemic months, with slow declines between May and July 2020. In spite of decreases, telehealth utilization rates in July 2020 (1,792 visits/1,000 members) were still significantly higher than in February 2020 (91 visits/1,000 members).

Initial increases in the use of telehealth services in March and April were driven in part by a telehealth expansion executive order, which loosened statutory restrictions enabling more telehealth services and payments, and by the cessation of elective services executive order enacted during the same time period that was aimed at slowing the spread of the virus. Declines in telehealth were anticipated after the cessation order was lifted at the end of April, and while the analysis shows declines overall, use of telehealth remains higher than prior to the pandemic, and is still increasing in some instances.

During the March to July period, behavioral health providers served the most people via telehealth services as opposed to primary care providers pre-pandemic. Use of telehealth with behavioral health providers spiked for Medicaid patients in April, and decreased between May and July. However, rates of utilization for behavioral health providers went up between May and July for both commercially insured patients and those with Medicare Advantage. Even with decreases for Medicaid patients, rates of visits with behavioral health providers in July 2020 (1,009 visits/1,000 members) were much higher than in February 2020 (55 visits/1,000 members).

Mental health conditions remain the most frequent diagnosis for telehealth services and increased from approximately 30% pre-COVID to a little over 50% of all visits between March and July 2020. With the addition of May-July data, respiratory conditions are no longer in the top four diagnoses for telehealth services. Endocrine/nutritional conditions (7%) are now in the top four list in addition to musculoskeletal (6%) and nervous system conditions (6%).  Established patient office visits remain the most common service offered during the COVID pandemic followed by psychiatric services and procedures.

Alamosa, a rural county in Southwest Colorado, remains the county with the highest overall telehealth utilization rate. However, in general, between March and July 2020, utilization in most rural counties was nearly half that of their urban counterparts.

CIVHC plans to continue updating the telehealth analysis frequently to enable evaluation of the impact of the COVID-19 pandemic on use of telehealth services and patient outcomes long-term.