Virtual healthcare trends are solidifying in the post-pandemic landscape, prompting stakeholders to focus on delivering value through technology implementation.
For those looking to understand telehealth 2.0, as some proponents have termed the post-pandemic virtual care landscape, the devil is in the data. And the data reaffirms some sobering trends, primarily that telehealth is popular only in some clinical areas and in-person care remains the preferred care delivery mechanism among patients and providers.
According to Sanjula Jain, Ph.D., senior vice president of market strategy and chief research officer at Trilliant Health, this should not surprise anyone who has followed the data since day one. Last week, the market research firm released its "2024 Trends Shaping the Health Economy" report, a national analysis of data and trends defining the healthcare landscape. The fourth annual report builds on findings published in the 2023 report, indicating that certain virtual care trends are becoming a part of the new normal.
Jain noted in an interview that as these trends stabilize, healthcare stakeholders need to change the questions they are asking and focus on the true value proposition of virtual healthcare.
Key report findings on virtual care use and adoption
For the report, researchers analyzed data from Trilliant Health's national all-payer claims database, provider directory, health plan price transparency data set and publicly available sources, such as health system, health plan and company financial statements, the Census Bureau, the Congressional Budget Office and the American Hospital Association.
The report reveals an enduring preference for in-person care, emphasizing that virtual care is best suited to only a few clinical use cases. In fact, a majority of patients in each age group chose in-person care in 2023, with only about a third of adults 18 and older selecting telehealth visits.
The report further notes that patients feel they receive a more detailed and complete physical examination and experience direct, visual, comfortable and better communication during in-person appointments.
Before stakeholders make significant investments in any new technology or innovation, they should really understand the data behind utilization and adoption, not based off of theory or what I think it will be or what patients tell you they want, but actually rigorous analysis to understand, okay, what is a clinical utility?
Sanjula Jain, Ph.D.Senior vice president of market strategy and chief research officer, Trilliant Health
Physicians appear generally satisfied with telehealth, though the level of satisfaction varies by specialty. For instance, only 18.5% of primary care physicians say they are dissatisfied with telehealth compared with 25.2% of surgeons and 20.6% of medical specialists.
Jain stated that these figures underscore the fact that virtual care isn't appropriate for all clinical use cases.
"There are very few things you can do clinically that make sense for a virtual interaction," she said. "Let's take oncology, for example. Even if you are just doing a follow-up, kind of E/M [evaluation and management] type visit with your oncologist, there's still an element of checking your vitals and physical touch that needs to happen to assess how you're doing in between your treatments. That cannot happen virtually right now. The patient may say, 'That would be more convenient for me -- I don't have to drive in.' But that is not clinically appropriate."
However, virtual care is proving especially effective in one arena: behavioral healthcare. The report shows that telebehavioral healthcare rose from 42% in the first quarter of 2020 to 72.3% in the fourth quarter of 2023.
Despite the drop in virtual care use overall, health systems are continuing to invest in virtual care tools. Most health systems (76%) invested in virtual health tools in 2024 to drive patient experience and access, while 61.5% invested in digital front doors, 53.5% in remote patient monitoring and 48% in virtual care tools to address labor shortages.
Additionally, the report shows that a vast majority of health system leaders (71.1%) believe that 11% to 50% of care can be delivered virtually.
Still, as healthcare leaders continue to invest in virtual healthcare, Jain cautions that leaders must sift through the data, separating fact from hyperbole, to determine the areas where virtual healthcare investments will yield the highest return on investment.
Identifying the value of virtual healthcare
The latest Trilliant Health market report shows that some trends outlined in the 2023 report are here to stay.
For instance, last year's report revealed that telehealth visit volume dropped 45.8% from the second quarter of 2020 to the fourth quarter of 2022. Additionally, the majority of people (80.2%) who used telehealth in 2022 had four or fewer visits. The 2023 report also showed that telebehavioral healthcare services spiked 45-fold since the onset of the COVID-19 pandemic, with 32.8% of all behavioral health visits conducted through telehealth in Q2 2022.
As these trends solidify, Jain emphasized the importance of using data to guide virtual care investments.
"Before stakeholders make significant investments in any new technology or innovation, they should really understand the data behind utilization and adoption, not based off of theory or what I think it will be or what patients tell you they want, but actually rigorous analysis to understand, okay, what is a clinical utility? What is the economic comparison? What investments do you need to actually integrate X innovation into the workflow? What are the potential savings from that?" she said.
Jain added that virtual care is not a one-size-fits-all solution. The above questions can help health system leaders better understand the ROI of virtual care in different clinical areas, allowing them to be more strategic with their investments.
Not only that, but health system leaders must also be realistic about adoption, tempering the overblown expectations the COVID-19 pandemic might have set.
"We have a tendency to talk about innovations as, okay, if we're at 0.8 today, that 0.8 is going to be ten times tomorrow," Jain said.
However, Jain pointed out that it took 20 years and a global health crisis to boost virtual care adoption to the heights it reached during the pandemic, and in the next 10 years, this figure will likely continue to level out or drop. This is why health system leaders should focus on the rate of change to get a sense of how adoption may evolve.
"Everybody threw a ton of money on [telehealth] because telehealth is the future," Jain said. "They didn't actually quantify the magnitude of that change. Is it going to be all Americans are using telehealth? Is it going to be only X type of patient or X type of market? We didn't really carefully assess it that way."
Determining the rate of change in adoption will be critical not only to understanding the prospects of virtual healthcare but also to assessing other buzzy technologies, like AI.
Jain said that applying lessons from the virtual care boom to AI could help healthcare stakeholders focus on the right questions from the start and follow the data more closely to guide investment decisions.
"We have a tendency in healthcare to talk about time and maturity with technology innovation, which, of course, things mature over time," Jain said. "AI is not new. It has been around for a while. It is just now maturing, and we're seeing it play out in different ways. But we have enough data in healthcare's history to understand the early trajectory of AI in clinical applications."
Assessing and strategically implementing technology is especially critical amid worsening health outcomes in the U.S. The report shows that mortality rates for people under age 65 are on the rise, infant and maternal mortality is well above other high-income countries and chronic conditions, like chronic liver disease and cirrhosis and early onset breast, colon, kidney and uterine cancers, are up among adults younger than 45.
At the same time, healthcare spending is expected to soar by 72.6% over the next decade, from $4.5 trillion in 2022 to $7.7 trillion in 2032, the report states.
In this challenging landscape, Jain believes that delivering value to the patient needs to be the guiding light for all healthcare stakeholders.
"I would say the punchline is this: we as a U.S. healthcare system are not getting enough value or ROI, whatever word you want to use," Jain said. "The amount being invested into the healthcare system -- whether that's your dollars, insurance coverage, access from policy initiatives, expanding telehealth technology, medications, whatever you want to define as the inputs to the U.S. healthcare system, spending is going up -- but we don't have anything to show for it. And not that we do not have anything to show for it; we actually have worse outcomes to show. That is a problem and an inflection point for the country."
Anuja Vaidya has covered the healthcare industry since 2012. She currently covers the virtual healthcare landscape, including telehealth, remote patient monitoring and digital therapeutics.