Telehealth Visits Decline 46%, But Telebehavioral Healthcare Still High

Telehealth visit volume dropped from 76.6 million visits in the second quarter of 2020 to 41.5 million visits in the fourth quarter of 2022, representing a 45.8 percent decline, according to a new report by market research firm Trilliant Health.

The 2023 Trends Shaping the Health Economy Report aims to provide insights into prominent trends in the healthcare sector. Data was gathered from numerous sources, including Trilliant Health's national all-payer claims dataset, which combines commercial, Medicare Advantage, traditional Medicare, and Medicaid claims; the firm's consumer dataset, which includes psychographic, demographic, social determinants of health, and lifestyle data; health system, health plan, and company financial statements; the Census Bureau; Kaiser Family Foundation; and the Centers for Disease Control and Prevention (CDC).

Not only did overall telehealth visit volume decline, but the majority of people (80.2 percent) who used telehealth in 2022 had four or fewer visits. Only 2.5 percent of telehealth users were super-utilizers, participating in 25 or more virtual visits. Super-utilizers were mostly younger, with an average age of 34.6 years, and female (65.6 percent).

Amid this decrease in telehealth use, the report shows that more than half of physicians (61 percent) and a third of patients (33 percent) believe that video visit quality is worse or much worse than in-person visit quality. On the other hand, only 6 percent of physicians and 16 percent of patients perceive video visit quality as better or much better than in-person care quality.

"These views are driven by concerns related to the inability to conduct physical examinations, technical difficulties and communication difficulties," the report states.

Despite this low perceived quality of virtual care, behavioral health remains a top telehealth use case. Between Q1 2020 and Q4 2022, the share of telehealth visits for behavioral health conditions jumped from 41.8 percent to 62.8 percent.

However, in 2021-2022, in-person follow-ups were driven primarily by behavioral health conditions.

Around 11.1 percent of all telehealth visits resulted in an in-person follow-up visit within a week for the same clinical reason. The top three diagnoses requiring an in-person follow-up were reactions to severe stress and adjustment disorders, recurrent major depressive disorder, and pervasive developmental disorder.

Additionally, 56.5 percent of telehealth visits resulted in an in-person follow-up within three weeks. These follow-ups were also largely driven by behavioral health diagnoses, with reactions to severe stress and adjustment disorders, other anxiety disorders, and recurrent major depressive disorder being the top three diagnoses.

When behavioral health conditions are excluded, 16.7 percent of telehealth in 2021-2022 resulted in an in-person follow-up visit for the same clinical reason after one week, and 29.2 percent resulted in an in-person follow-up visit for the same clinical reason within three weeks. On removing behavioral health diagnoses, top diagnoses resulting in an in-person follow-up were contact with suspected exposure to communicable disease, encountering health services for other counseling and medical advice, general examination, and type 2 diabetes.

The report aligns with Trilliant Health's 2022 Trends Shaping the Health Economy Report, which showed that telehealth visit volumes fell 37 percent from Q2 2020 to Q1 2022. Further, like the 2023 report, virtual behavioral healthcare services experienced an increase, rising from 32.4 percent of all telehealth visits in Q1 2019 to 59.9 percent in Q1 2022.

Another Trilliant Health report showed that traditional Medicare recorded the highest share of behavioral health services delivered via telehealth, with these visits rising from less than 2 percent in Q1 2019 to 48.6 percent in Q2 2022. Traditional Medicare was followed by Medicare Advantage, with 40.1 percent of behavioral health visits conducted virtually in Q2 2022, Medicaid with 36.7 percent, and commercial insurance with 31.8 percent.