Statistical Analysis of Telehealth Use and Pre- and Postpandemic Insurance Coverage in Selected Health Care Specialties in a Large Health Care System in Arkansas: Comparative Cross-Sectional Study (Preprint)
Authors: Cengil Aysenur Betul , Eksioglu Sandra , Eksioglu Burak , Eswaran Hari , Hayes Corey J , Bogulski Cari A 
Published: May 2023

BACKGROUND

The COVID-19 pandemic triggered policy changes in 2020 that allowed insurance companies to reimburse telehealth services, leading to increased telehealth use, especially in rural and underserved areas. However, with many emergency rules ending in 2022, patients and health care providers face potential challenges in accessing these services.

OBJECTIVE

This study analyzed telehealth use across specialties in Arkansas before and after the pandemic (2017-2022) using data from electronic medical records from the University of Arkansas for Medical Sciences Medical Center. We explored trends in insurance coverage for telehealth visits and developed metrics to compare the performance of telehealth versus in-person visits across various specialties. The results inform insurance coverage decisions for telehealth services.

METHODS

We used pre- and postpandemic data to determine the impacts of the COVID-19 pandemic and changes in reimbursement policies on telehealth visits. We proposed a framework to calculate 3 appointment metrics: indirect waiting time, direct waiting time, and appointment length. Statistical analysis tools were used to compare the performance of telehealth and in-person visits across the following specialties: <i>obstetrics and gynecology</i>, <i>psychiatry</i>, <i>family medicine</i>, <i>gerontology</i>, <i>internal medicine</i>, <i>neurology</i>, and <i>neurosurgery</i>. We used data from approximately 4 million in-person visits and 300,000 telehealth visits collected from 2017 to 2022.

RESULTS

Our analysis revealed a statistically significant increase in telehealth visits across all specialties (<i>P</i>&lt;.001), showing an 89% increase from 51,589 visits in 2019 to 97,461 visits in 2020, followed by a 21% increase to 117,730 visits in 2021. Around 92.57% (134,221/145,001) of telehealth patients from 2020 to 2022 were covered by <i>Medicare</i>, <i>Blue Cross</i> and <i>Blue Shield</i>, <i>commercial and managed care</i>, <i>Medicaid</i>, and <i>Medicare Managed Care</i>. In-person visits covered by <i>Medicare</i> and <i>Medicaid</i> decreased by 15%, from 313,196 in 2019 to 264,696 in 2022. During 2020 to 2022, about 22.84% (33,123/145,001) of total telehealth visits during this period were covered by <i>Medicare</i> and 53.58% (86,317/161,092) were in <i>psychiatry</i>, <i>obstetrics and gynecology</i>, and <i>family medicine</i>. We noticed a statistically significant decrease (<i>P</i>&lt;.001) in the average indirect waiting time for telehealth visits, from 48.4 to 27.7 days, and a statistically significant reduction in appointment length, from 93.2 minutes in 2020 to 39.59 minutes in 2022. The indirect waiting time for <i>psychiatry</i> telehealth visits was almost 50% shorter than that for in-person visits. These findings highlight the potential benefits of telehealth in providing access to health care, particularly for patients needing psychiatric care.

CONCLUSIONS

Reverting to prepandemic regulations could negatively affect Arkansas, where many live in underserved areas. Our analysis shows that telehealth use remained stable beyond 2020, with <i>psychiatry</i> visits continuing to grow. These findings may guide insurance and policy decisions in Arkansas and other regions facing similar access challenges.