The Minneapolis Star Tribune looks at the  MN Department of Health has released a new report, Study of Telehealth Expansion and Payment Parity (I wrote about it last month.) …

“The picture of telehealth is getting clearer,” said Pam Mink, the MDH director of health services research. “It’s really evolved into a lot of aspects of primary care.”

The report said the state Legislature should continue investing in telehealth and encouraging its use after it became a lifeline during the COVID-19 pandemic. Telehealth use increased from 3% of primary care visits among privately insured Minnesotans in 2019 to more than 20% in 2021, the report showed. But even in 2022, when no pandemic restrictions were in place, patients chose it for 19% of those visits.

Online options such as Virtuwell remain available, pairing patients with doctors they likely haven’t seen before to make routine diagnoses and issue quick prescriptions. But the post-pandemic growth has largely been among primary care doctors in their visits with established patients, especially those needing regular checkups and medication adjustments for chronic conditions such as diabetes and depression.

They also look at mental health services…

Telehealth has grown especially popular for mental health appointments, but it can address many physical ailments, said Dr. Annie Ideker, an associate medical director who led the post-pandemic expansion of telehealth at HealthPartners clinics and hospitals. On one shift last week, Ideker conducted online sessions with patients who had Parkinson’s disease, osteoporosis, anxiety, high blood pressure and acid reflux. She said she has assessed orthopedic issues remotely by having patients demonstrate their range of motion on screen.

“It’s two-dimensional, and you’re only seeing their face, so you might miss some of the body language, like if they are tapping their foot under the desk or something,” she said. “It’s just a matter of being aware of that and using other techniques to try to elicit some of what you might be missing.”

There were some issues…

The state report offered mixed results in terms of the impact of telehealth on quality of care. Patients using telehealth were more likely to do checkups after hospitalizations, which are recommended to address any overlooked or delayed complications that could send patients right back into hospital care.

It’s all part of an ongoing discussion…

The state findings could inform an ongoing federal debate. Congress is under time pressure to decide before the end of the year whether to extend federal COVID-era policies that allowed all providers to offer telehealth to Medicare recipients and to pay for telehealth visits at the same rates as in-person visits.

Telehealth didn’t inflate health care spending in Minnesota, the study found, but there was no evidence of savings, either. The hope is that telehealth will reduce health care spending by increasing medical checks on chronically ill patients and preventing them from suffering costly and preventable complications. But the timeframe of the report was too narrow to document long-term effects.

Scholars looked at Predictors of Telehealth Use After MN Telehealth Act. They looked at who was using it and how that impacted in-person appointment and the impact of the in-person appointment versus online to patients. The Act extended coverage to telehealth but will be expiring in the next year…

We extend the analysis described in the preliminary report to the Minnesota Legislature for the Minnesota Telehealth Study. We used data from the Minnesota All Payer Claims Database (MN APCD) to examine predictors of telehealth use in 2022 – when health care use returned to pre-pandemic levels – among commercially insured and Medicare Advantage (MA) patients. By focusing on telehealth users or what predicted telehealth use in a period following the implementation of the Minnesota Telehealth Act and after the worst phase of the pandemic, we sought to provide policymakers with critical information on patient subgroups more likely to be affected by future telehealth policies. Also, for patient subgroups predicted to have a higher likelihood of telehealth use, we examined ambulatory care use to better understand telehealth use patterns, for instance, whether the proportion of telehealth visits differed based on potential underlying factors.

Here’s what they found…

In the absence of policies supporting greater audiovisual telehealth use or promoting access to in-person care, limiting access to audio-only telehealth could adversely affect high-need patients more than others. Further research is needed to understand how telehealth use affects outcomes among high-need patients and whether expanded access to telehealth comes at the expense of or enhances patient satisfaction and care quality.

Here’s a factor that speaker to the need for better ubiquitous broadband…

Convenience and widespread access to broadband internet are as important as higher health care need in driving use of telehealth services. If ease of access drives some telehealth use and telehealth is not a perfect substitute for in-person visits, the total number of ambulatory visits is likely to increase with expanded access to telehealth.

Wilderness Health reports on students from the University of Minnesota who presented work on the future of Telehealth and of Mental and Behavioral Health to the Telehealth Committee of Wilderness Health on May 28, 2024. They looked at both Minnesota and Wisconsin, where they found similarities and differences.

Some key findings:

• Where Minnesota’s Medicaid expansion has vastly increased access to mental and behavioral healthcare, Wisconsin, in refusing that package, has struggled to find everyone the help that they need.  Minnesota’s increased access has not been matched by an increase in providers, though – the waits remain long, and so remain a barrier.
• Similarly, Wisconsin participates in a number of interstate compacts that widens who can deliver care via telehealth.  Minnesota licensure boards across different types of care providers have been more cautious in regulating who can deliver care via telehealth, restricting care to Minnesota residents by out-of-state caregivers – creating waits, again.  Wisconsin does have significant gaps in reimbursement as compared to Minnesota, which then results in fewer providers willing to accept Medicaid patients.

Telehealth is essential healthcare. They found some policy issues that serve as a barrier to access and offered some recommendations:

• Students also explored the need to support residents of both Minnesota and Wisconsin across the “digital divide.” Lower-cost access to high-speed internet, training on devices and software, and help with assistive technology for those with disabilities are key to ensuring everyone can benefit from telehealth.
• The conversation with the Telehealth Committee also brought up reimbursement issues. Payment parity (or equivalent payment) for audio-only visits is also especially important to ensure those who cannot navigate video visits can still receive care. Also in both states, patients and providers are served better when mental and behavioral health is reimbursed at rates that meet the costs to provide the care.

They also created a series of policy briefs:

• Telehealth Triumph and Policy Imperatives
• Driving Transformation in Mental and Behavioral Health Care Through Policy