The Role of Telehealth in COVID-19 Response

ABSTRACT Concern over the safety of in-person visits and related policies have resulted in unprecedented uptake of telehealth in 2020. Simultaneously, utilization of other outpatient services has plummeted. Telehealth service providers with national penetration are uniquely positioned to address the resulting gap in near real-time syndromic surveillance. To date, 51,929 patients from our sample meet one of the two international case- identification standards for COVID-19, yet these reports are only required and included in surveillance systems of 9 states. We will investigate how near-real time data can be incorporated into existing and newly implemented local and national public health reporting infrastructure. Using insurance claims from 1.7 million patients, we will cross-validate these reports and investigate changes in patterns of service utilization and outcomes for respiratory infections and ambulatory care sensitive conditions. By incorporating outcomes from claims data with new knowledge and case reporting criteria into our existing system, we have the opportunity to rapidly update and disseminate evidence and practice guidelines. Our analysis environment links the Teladoc® electronic medical record with continuous updates of beneficiaries' data since 2018 with at most a 90 day delay. This linked longitudinal data set includes both telehealth and non-telehealth patients and supports further analysis of outcome differences and associated changes due to the pandemic. The first specific aim of our study is to assess validity and feasibility of using this information system for public health surveillance. The second aim will measure practice and outcome variation for patients with COVID-19 symptoms, including off-label prescribing and referral patterns. The third aim will assess how utilization changes have impacted quality indicators for AHRQ Ambulatory Care Sensitive Conditions and disparities. We will assess the extent to which telehealth explains these variations in practice and outcomes. If successful, our work will have immediate value informing the response to the COVID-19 pandemic, and has implications for understanding the secondary impact of the pandemic on Ambulatory Care Sensitive Conditions.