Outcomes Research Practice Leader IBM Watson Health, United States
Background: The COVID-19 outbreak has restricted in-person visits in healthcare systems.
Objectives: To compare the characteristics of new telemedicine users before and after COVID-19 in the U.S.
Methods: This retrospective claims analysis captured telemedicine users in pre-COVID-19 (3/1/2019 – 7/31/2019) and post-COVID-19 (3/1/2020 – 7/31/2020) using IBM MarketScan® Commercial and Medicare Supplemental Research Databases. The pre- and post-cohort consisted of patients with ≥1 telemedicine claim in March – July of each year (index date = date of first telemedicine), continuous enrollment in March – July and 12 months pre-index, and no telemedicine claim in pre-index. Overlapping patients between cohorts were excluded. Patient’s demographic and clinical characteristics were compared using chi-square tests for categorical variables and t-tests for continuous variables.
Results: Among people continuously enrolled in March – July, the proportion of patients with ≥ 1 telemedicine visit increased nine times post-COVID-19 (0.27% [N=23,479] vs. 0.03% [N=6,397]). Compared with new telemedicine users in 2009 (N=3,408), new telemedicine users in 2020 (N=20,344) were significantly older (mean 57.2 [stand deviation 21.5] vs. 43.3 [20.0] years), more likely to be covered by Medicare (49.3% vs. 12.6%), be females (60.4% vs. 55.3%), and live in Northcentral and West regions (40.0% and 20.1% vs. 25.8% and 10.2%) and urban areas (89.4% vs. 72.7%). In addition, new telemedicine users in 2020 were sicker, as reflected by a higher pre-index Deyo Charlson Comorbidity Index (1.8 [2.5] vs. 0.8 [1.8]) and higher rates of pre-index chronic conditions such as cardiovascular disease, osteoarthritis/osteoporosis, diabetes, and cancer. P values were <0.01 for all comparisons. In 2020, top diagnoses on telemedicine visit were hypertension (27.5%), hyperlipidemia (10.2%), and type 2 diabetes (7.5%) for patients aged 65+ years; top diagnoses for patients aged <65 years were hypertension (4.8%) and generalized anxiety disorder (3.1%). During the post-index period, new telemedicine users had a significantly decreased number of physician office visits (2.6 [2.4] vs. 9.2 [8.5], p<0.01) post-COVID-19 vs. pre-COVID-19.
Conclusions: There was a substantial increase in telemedicine use since the COVID-19 outbreak. New telemedicine users became older, sicker and had substantially fewer physician office visits, reflecting the healthcare utilization shifts due to personal choice or lock down policies. Patients’ healthcare outcomes and costs before and after COVID-19 needs more investigation to better understand the impact of the pandemic on patients, providers, and payers.
