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New York’s Economy and Finances in the COVID-19 Era (June 24, 2021)

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New York’s Economy and Finances in the COVID-19 Era

June 24, 2021 Edition

Growth in Use of Telehealth Services Among Medicaid and Child Health Plus Beneficiaries in New York

The COVID-19 pandemic prompted many changes in the ways New Yorkers conducted daily activities, with remote learning and remote work becoming common in New York and across the country. The pandemic also spurred a change in how people sought and received medical care; rather than visiting medical practitioners in person, increasing numbers of people used telehealth services. While telehealth usage in New York and nationally has declined since the pandemic peak, it remains well above pre-pandemic levels, though still only a small share of overall utilization.

The U.S. Centers for Medicare & Medicaid Services (CMS) defines telehealth services as “the exchange of medical information from one site to another through electronic communication to improve a patient’s health.” Often, these services are performed through live audio or video conferencing. While comprehensive data on telehealth visits performed across all provider and service categories are unavailable, CMS data on telehealth utilization among New York Medicaid and Child Health Plus (CHP) beneficiaries are available for the period from January 2018 through November 2020 (the most recent information available).

Telehealth services provided to New York beneficiaries began to increase before the pandemic, growing from slightly more than 1,200 monthly in January 2018 to almost twice that amount in January 2019 (see Figure 1). By January 2020, just prior to the pandemic, telehealth utilization had more than doubled again, reaching over 5,000 visits per month.

FIGURE 1: New York Medicaid and CHP Monthly Telehealth Utilization, January 2018 through January 2020

Source: U.S. Centers for Medicare & Medicaid Services

Starting in March 2020, telehealth services utilized by the State’s Medicaid and CHP beneficiaries climbed sharply to 208,506 visits, as shown below. As the State entered a lockdown in April, telehealth use reached a record 707,588 monthly visits. In April 2020, the usage rate was 102 telehealth services per 1,000 beneficiaries, compared to less than 1 service per 1,000 beneficiaries prior to March 2020.

As the State began to ease restrictions, telehealth use declined steadily through October 2020, and then dropped precipitously in November 2020 to 41,767 from 292,237. Even in November 2020, telehealth use was still eight times greater than the previous January.

FIGURE 2: New York Medicaid and CHP Monthly Telehealth Utilization, January 2020 through November 2020

Source: U.S. Centers for Medicare & Medicaid Services

Demographic data show that adults from 25 through 64 years of age accounted for 59 percent of all telehealth services for Medicaid and CHP beneficiaries from March through November 2020, as shown in Figure 3. Female beneficiaries accounted for 62 percent during the same period.

FIGURE 3: New York Medicaid and CHP Telehealth Utilization by Age, March 2020 through November 2020 Total

Source: U.S. Centers for Medicare & Medicaid Services

Some services were more likely to be performed via telehealth than others. The CMS data about the types of telehealth services used by the State’s beneficiaries during the pandemic period show 70 percent were categorized broadly as office or outpatient evaluation and management (E/M) and another 26 percent were behavioral health E/M, as shown in Figure 4. Other services were not commonly performed via telehealth: physical, occupational and speech therapy telehealth visits accounted for just 1 percent of usage; and home health, nursing facility and emergency department services were less than 1 percent.

FIGURE 4: New York Medicaid and CHP Telehealth Utilization by Type of Service, March 2020 through November 2020 Total

Note: Types of service may overlap.
Source: U.S. Centers for Medicare & Medicaid Services

Policy Implications

Growth of telehealth utilization in New York followed the national trend: CMS reported a 2,745 percent increase in telehealth services nationally in the eight-month period from March to October 2020 compared to the same period in 2019. The recent sharp rise of telehealth services was enabled by federal policy changes that included enhanced flexibility under Health Insurance Portability and Accountability Act (HIPAA) privacy provisions, temporary waivers issued by CMS to permit Medicare, Medicaid and CHP beneficiaries to receive telehealth services, and allowance by the U.S. Health and Human Services Department for physicians and practitioners to reduce or eliminate co-pays for such services for beneficiaries of federal programs.

By statute, New York has required health insurers, including Medicaid, to pay for the delivery of covered services through telehealth starting on January 1, 2016. Based on the most recent guidance publicly available, posted in May 2020, the State Health Department allows New York Medicaid providers the same reimbursement for delivering some services via telehealth during the pandemic, while others are paid at specialized rates.

It is unclear whether telehealth services are more cost-effective than in-person services, and whether the medical system will adapt to provide more telehealth services. Recent research by the Tufts University Center for Health Systems and Policy found that: “Evidence of cost savings associated with telehealth is mixed and depends on whether telehealth is used to increase access to new patient populations, or as a substitute for current levels of in-person care, as well as the context for care delivery.” Another recent study by international researchers cites positive evidence for patient benefits and provider productivity, but does not find decreases in the cost of care.

The extent to which telehealth services represented an expansion of care that would not have otherwise been sought is also unclear. For example, a survey by the RAND Corporation found a greater share of people turning to telehealth for behavioral services than prior to the pandemic. Telehealth services may have reduced barriers for seeking help and allowed some to seek treatment they may not have sought in person.

A recent audit report by the Office of the State Comptroller lends support to this finding. The audit found that although the Office of Mental Health (OMH) has expanded telemental health (TMH) regulations during the COVID-19 pandemic, there are opportunities for OMH to improve access to TMH and there is a risk that some patients may no longer be able to access the mental health services they need once the COVID-19 emergency period ends. As of December 2020, OMH had approved only 141 of 448 providers offering TMH to use it beyond the emergency period. The audit recommended that OMH:

  • work with providers to increase their ability to offer TMH as a service to clients when it is deemed an appropriate method of treatment; and
  • develop defined processes and procedures related to overseeing TMH beyond OMH’s initial approval process.

The audit finding is notable considering New York lags other states in telehealth use, even when usage surged during the pandemic. During the March to October 2020 period, CMS reports that New York was in the lowest quintile of service use, with up to 7,000 average monthly telehealth services per 100,000 Medicaid and CHP beneficiaries. In contrast, rates were more than 25,000 services per 100,000 beneficiaries in neighboring Massachusetts and Connecticut.

Prior Editions

Thomas P. DiNapoli

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