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Telehealth use increased dramatically from 2019-2021, but varied by state, age, and area-level social determinants of health

Building on existing work on telehealth use early in the COVID-19 pandemic among people who get health insurance through work, HCCI examined the use of telehealth services by year through 2021.

We examined patterns of telehealth use by modality (synchronous or asynchronous) and state, as well as select measures of area (zip or county)-level social determinants of health as reported in AHRQ's Social Determinants of Health Database (specifically: broadband access, computer access, rate of primary care and mental health providers per population, and median income).

We counted both claims and unique patients who used each service and applied a year, age, sex, and zip code-based weight from the American Community Survey to make our estimates representative of the ESI population in the U.S. National and state level downloadable data are available below. Note that data from some states are not available due to small sample size.

Key Findings:

  • Telehealth visits in the ESI population increased by over 6,000% from 2019 to 2020 and remained near 2020 levels in 2021.
  • Most telehealth visits were synchronous (real-time), with only a small fraction (0.2-0.4%) conducted asynchronously.
  • In 2020 and 2021, a larger share of people living in urban areas had a telehealth visit (17-20%) compared to people living in rural areas (10-13%).
  • Enrollees ages 35-44 had the highest rate of telehealth visits, however, a larger share of enrollees ages 45-64 had any telehealth visit in 2020 and 2021.
  • In 2020, most telehealth claims were for mental health visits (41%), followed by primary care visits (30%). The share of telehealth claims for mental health visits increased from 2020 to 2021 to 52%.
  • A greater share of enrollees living in zip codes with more primary care and mental health providers per person had a telehealth visit compared to enrollees living in zip codes with fewer providers per person.
  • Enrollees living in zip codes with a higher median household income had higher use of telehealth visits. For example, in 2020 23% of people in zip codes with the highest median income (>=$74,522) had a telehealth visit compared to just 16% of people in zip codes with the lowest median income (<=$46,162).
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