Enrollment in Integrated Health Plan Drove Telehealth Use in California

A new study shows that higher telehealth use was linked to enrollment in a clinically and financially integrated health insurance plan versus a nonintegrated health plan.

Published in Health Affairs, the study aimed to examine how the adoption of telehealth and its use varied across payment models during the COVID-19 pandemic.

In the US, telehealth is reimbursed at lower rates than in-person care, though the pandemic made the gap smaller than it had previously been. This creates a difference in incentives for providers, the researchers note. Providers in fee-for-service models may be incentivized to favor in-person care over telehealth. In contrast, those participating in capitation models, where the provider is responsible for increased costs, may have a financial incentive to use telehealth but may also skip necessary or "high-value" care, according to the study authors.

For the study, researchers used medical claims data from CalPERS, which provides insurance coverage to all state of California employees, retirees, and their dependents. The enrollees have several health plan options, including Kaiser Permanente health plans, which are paid on a fully capitated basis.

The researchers studied 2019-20 claims data for 1.1 million CalPERS enrollees. They compared monthly telehealth use rates per 1,000 CalPERS enrollees to assess differences in telehealth use.

Further, to examine how health plan choice contributed to differences in telehealth use, the researchers separately studied the differences between CalPERS enrollees who received insurance from Kaiser and those covered under all non-Kaiser plans combined. About 50 percent of the total study population was enrolled in Kaiser plans.

The study shows that before the pandemic, CalPERS enrollees covered by a Kaiser health plan used telehealth much more than non-Kaiser enrollees. This trend continued after the pandemic hit, with non-Kaiser enrollees' telehealth use declining after April 2020 and Kaiser enrollees' telehealth use peaking at 295 claims per 1,000 in August 2020.

In addition, researchers found that before and during the pandemic, telehealth use was highest among patients located in ZIP codes that were lower income, had more non-White residents, and had more non-English language speakers.

But, after controlling for Kaiser versus non-Kaiser enrollment, the income, race, and language differences in telehealth use during the pandemic "decreased in magnitude and were less associated with the use of telehealth than was Kaiser enrollment," the researchers wrote.

Thus, a health plan that "both clinically and financially integrates providers and payers had higher and more equitable use of telehealth during the COVID-19 pandemic," they concluded.

To reduce inequities in telehealth use, the researchers recommend that policymakers and healthcare purchasers consider the underlying provider incentives to adopt telehealth.

Ensuring equitable use of telehealth is crucial as virtual care options remain popular among healthcare stakeholders.

Recent data from FAIR Health shows that telehealth's share of all medical claim lines did not change from August to September, remaining stable at 5.4 percent in both months.

Further, Americans continue to see value in telehealth use, mainly due to the convenience it affords. Survey results released by America's Health Insurance Plans (AHIP) show that 69 percent of commercially insured telehealth users said they used telehealth due to the associated high level of convenience compared to in-person care and 78 percent stated that telehealth made the process of seeking out healthcare easier.