Two very divergent views on the future of telehealth were published this week. Bloomberg Intelligence on the economics side is seeing nothing but blue skies for telehealth for the next five years, while predictive analytics shop Trilliant Health crunches their numbers and sees the opposite picture. Trilliant predicts the downward trend, which they first observed in their mid-2021 [TTA 30 June 2021] healthcare report, will continue except in the select area of mental health. Here are their predictions:

In Bloomberg Intelligence’s Digital Reshaping the Health-Care Ecosystem report, their projection is that telehealth by 2027 will be at minimum $17 billion of healthcare revenue. Their target numbers are $20 billion and 15% of outpatient visits with a three-year compound annual growth of 25%. This is based on claims trends they see (we don’t–see our reports on FAIR Health’s claims data) as well as revenue consensus by public telehealth companies such as Teladoc. However, as the report puts it, it cannot completely account for telehealth acquisitions by larger managed-care companies or the extension of telehealth across existing consumer and patient platforms which if anything would increase the picture. 

• The ‘flywheel’ effect of the pandemic raised awareness of telehealth by both patients and providers
• Payers have moved aggressively to incorporate telehealth as their members demand it: CVS Aetna with Teladoc, UnitedHealth with NavigatorNOW, Cigna with Oscar (which has $0 co-pay virtual health plans in many states), Cigna-MDLIVE, and others.
• The ubiquity of mobile phones, smartphones and apps

From the report: “Virtual care will [increasingly] become the norm, we believe, after the pandemic pushed patients away from in-person visits. A reversion to old practices and business models appears impossible to us after the pandemic forced meaningful change across all the key constituents.”  The rest of the report covers international growth in remote patient monitoring, such as continuous glucose monitors (CGM) ($12 billion) and implantable and wearable cardiac monitors, based on similar corporate projections.

Trilliant Health’s Trends Shaping the Health Economy: Telehealth (e-doc and downloadable PDF) takes the opposite view–that telehealth usage continues to shrink inversely to in-person visits being restored.  It questions whether the “forced adoption” of telehealth over the past two years (March 2020 to November 2021) has actually changed patient and provider behaviors. Patients used it then, will they continue to use it in the future? It’s nowhere near a norm with the exception of growth in behavioral health. Demographically, utilization is uneven. Highlight findings:

• Even during the pandemic, only 25.6% of Americans used telehealth over the tracking period
• 46% of telehealth patients used it only once
• The total addressable market for telehealth is <1% of the health economy and declining, because most prefer in-person care
• Monthly usage continues to decline even with Covid variants
• Primary care visits continue to decline as well, but telehealth does not fill that gap
• The type of telehealth usage hasn’t shifted much, with audio-video leading the way with over 60% share
• 57.9% of telehealth visits were attributed to behavioral health diagnoses and is growing in share–and this has not changed pre/post-pandemic
• Between 2020 and 2021, 79% of telehealth patients had between one and four visits. But less than 3% of telehealth patients
  were “Super Utilizers” with 25 or more telehealth visits. And they’re younger–aged 21-36, female (58%), and live in high income areas.
• The psychographics of telehealth users is interesting. They are not the ‘Priority Jugglers’ of busy moms and hipsters you’d expect, accounting for 15% of users. 30% are “Willful Endurers” who live in the “here and now” and presumably turned to telehealth when they just couldn’t ignore an illness anymore, followed at 25% by their opposites–“Self Achievers” who are very proactive about their health and wellness.
• Most niche telehealth entrants are targeting the same discrete markets, like women, who will continue to use telehealth
• Most providers are not equipped to continue to provide telehealth, versus retail suppliers like CVS, Walmart, and Walgreens
• Public policy calling for permanent expansion of access is inconsistent with actual low telehealth utilization in the past two years, where in-person visits were limited, Medicare and insurance restrictions were put aside, and providers expanded availability

The report looks at all forms of synchronous and asynchronous telehealth modalities–the latter often lost in the shuffle–concentrating on synchronous audio-video and audio-only, plus asynchronous interactions such as email. This is a 69-page report worth your ponder; there are charts and graphs that lighten the load of their conclusions, which directionally seem to fit what this Editor has been seeing in since last autumn. Hat tip to Sanjula Jain, chief research officer of Trilliant. Also Healthcare IT News