Trends in Telehealth Care for Diabetes During the COVID-19 Pandemic

Importance:  This very large claims data analysis documents widespread adoption of telehealth use by patients with diabetes during the first year of the COVID-19 pandemic, giving us insight into the potential role of telehealth as we enter a stage of “new normal” of healthcare delivery in the U.S. Objective: The COVID-19 Telehealth Impact Study was designed to describe the natural experiment of telehealth adoption during the pandemic.  This focused analysis can assist program development for care of large populations of patients with diabetes.  Design, Setting, Participants: In March 2020, the MITRE Corporation and Mayo Clinic founded the COVID-19 Healthcare Coalition (C19HCC) and Telehealth Impact Study to respond to the pandemic. We report trends using a data set of over 2 billion healthcare claims covering over 50% of private insurance activity in the U.S. (January 2019-March 2021). Main Outcomes and Measures: We compared rates of telehealth use in the one-year pre and one-year post onset of the COVID-19 pandemic among a population of 8,339,633 patients with diabetes. Results: Compared to a baseline of very low telehealth use in 2019, there was rapid adoption of telehealth by patients with diabetes in Spring 2020.  27% of diabetics used telehealth in Q2 2020 and use rates declined in the ensuing months to approximately 13%.  Diabetics and their providers used telehealth to address a wide variety of health problems.  77% of telehealth visits addressed diabetes, 53% hypertension and over 40% of visits addressed mental and behavioral health diagnoses.  Audio-only (telephone visits) accounted for a substantial portion of telehealth encounters (10.0- 16.3%) and will be an important consideration for future telehealth planning.  Over the course of the first 12 months of the pandemic, 98% diabetics who used telehealth used 4 or fewer telehealth visit. Conclusions and Relevance: We believe that telehealth will quickly become a best practice for routine care of patients with diabetes and other chronic conditions.  Telehealth interactions 2-4 times per year supplemented with remote monitoring for glucose, blood pressure and weight have the potential to greatly enhance patient care. Further research will be needed to measure the telehealth impact on glycemic control, patient satisfaction and other outcomes.  We encourage CMS and other payers to embrace and promote use of telehealth based on this real-world experience of patients and providers during the pandemic.