Samara Rosenfeld

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In a study of more than 36.5 million U.S. individuals, ambulatory contacts decreased by 18% between the 2019 and 2020 March to June period while telehealth use increased from .3% of contacts in 2019 to 23.6% of all contacts in 2020.

Findings of the study suggested a dramatic shift in the adoption of virtual care and has many implications for health services provision during and after COVID-19.

Jonathan Weiner, Dr.PH., and colleagues documented patterns and costs of ambulatory care in the U.S. before the initial stage of the pandemic. They further assessed how patient, practitioner, community, and COVID-19-related factors were associated with telehealth adoption.

Study data came from the Blue Health Intelligence data repository, an independent data and analytics company that is a licensee of the Blue Cross and Blue Shield Association. The data included complete claims files for commercial health plan members continuously enrolled from March 1, 2019 through June 30, 2020. The analysis compared the four-month period of March through June in 2019 and 2020.

The team’s unit of analysis was an ambulatory encounter with a telehealth-eligible service. Encounters were defined as a patient seeing a specific practitioner on a specific date. Telehealth included any service provided on a remote basis, whether via video, telephone, asynchronous or synchronous text or email transmission, or other similar technology.

Demographic characteristics were collected, including age, sex, and zip code of residence from enrollment files. The team analyzed allowed charges to assess healthcare costs.

Overall, 36,568,010 individuals were included. In-person contacts decreased by 37% (from 1.63 to 1.02 contacts per enrollee). When the virtual contacts were added, the overall COVID-19 era patient and practitioner visit rate was 18% lower than in 2019 (1.34 vs 1.64 visits per person). Behavioral health visits were the most likely encounters to take place virtually (46.1% vs 22.1%).

Those living in places with limited social resources were less likely to use telehealth (most vs least, 27.4% vs 19.9% usage rates). Medical care costs decreased 15% between 2019 and 2020 from $358.32 to $306.04 per enrollee per month.

In-Person and Telehealth Ambulatory Contacts and Costs in a Large US Insured Cohort Before and During the COVID-19 Pandemic

Articles

Costs were lower for those who used telehealth services.

Exploring Costs Related to Increased Telehealth Use

Amy Abernethy, M.D., Ph.D., of the U.S. Food and Drug Administration (FDA) will be leaving the agency in the coming weeks, 

 sent to colleagues by Janet Woodcock, M.D., the acting FDA commissioner.

Abernethy, who spent two and a half years as the FDA’s principal deputy commissioner and acting chief information officer, dedicated herself to information technology and establishing standards for the use of real-world data and evidence.

During her time with the agency, the FDA partnered with numerous health technology companies, including one with Aetion to develop real-world data analytics to answer questions related to COVID-19.

“Evaluation of real-world data has the potential to provide a wealth of rapid, actionable information to better understand disease symptoms, describe and measure immunity and understand available medical product supplies to help mitigate potential shortages,” Abernethy said.

Under Abernethy, the FDA participated in the COVID-19 Diagnostics Evidence Accelerator to advance the development of diagnostics. 

 the accelerator would allow the community to analyze diagnostic and clinical data in real time which could contribute to the scientific evaluation of diagnostic tools and medical interventions for COVID-19.

The FDA also implemented the Technology Modernization Action Plan which consisted of three components: modernization of the FDA’s technical infrastructure and operations, enhancing the agency’s capabilities to develop technology products, and communication and collaboration with stakeholders to drive more seamless progression. The agency prioritized partnerships to drive such progress, including engaging with experts from government, industry, and academia to discuss data sharing, data exchange, putting data to use, and data stewardship and privacy.

"Amy’s innovative spirit is renowned in the medical field and she has a unique understanding of how to harness new technologies for the benefit of patients and the public health. But those who have worked with her directly know that she is also uniquely skilled as a manager and a mentor. Throughout multiple Commissioner transitions and a historic pandemic, Amy’s focus on the FDA’s core technology operations has resulted in a remarkable modernization of the agency’s technology and data practices. More than anything else, this modernization has been about the people behind technology at the FDA and how they can perform their work to best support our mission," Woodcock wrote.

Prior to her stint with the FDA, Abernethy was CMO of Flatiron Health and spent 25 years at Duke University where she directed the university’s career research program and cancer institute.

The data and technology expert spend nearly two and half years with the FDA.

Dr. Amy Abernethy Is Leaving FDA

Neil Evans, M.D., is an internist and the chief officer of connected care at Veterans Health Administration (VHA), the largest integrated healthcare system in the U.S. VHA provides care at 1,255 healthcare facilities, including 170 medical centers and 1,074 outpatient sites, and serves 9 million enrolled Veterans each year.

had the opportunity to speak to Evans about VHA's use of health technology, big data, wait times, and dealing with mental health and substance abuse issues.

Videos

A VHA expert discusses how the health system leverages data and technology.

Neil Evans, M.D., Says VHA's "Present and Future Are Bright"

Although hospitals have been releasing their previously confidential prices due to the new 

, they have blocked that information from web searches with coding embedded on their website, according to the 

In an examination of more than 3,100 websites conducted by investigators at the 

, it was revealed that hundreds of hospitals embedded code in their websites that prevented Google and other search engines from displaying pages with the price lists. The embedded code keeps pages from appearing in searches related to a hospital’s name and prices. Still, the prices are often accessible other ways, but are much more difficult and lengthier.

“It’s technically there, but good luck finding it,” Chirag Shah, an associate professor at the University of Washington, 

. “It’s one thing not to optimize your site for searchability, it’s another thing to tag it so it can’t be searched. It’s a clear indication of intentionality.”

It was revealed that some of the biggest U.S. healthcare systems and some of the largest hospitals in cities were using the blocking code, including hospitals owned by HCA Healthcare, Universal Health Services, the University of Pennsylvania Health System, and NYU Langone Health.

Officials at Penn Medicine, NYU Langone, and Novant Health said they used blocking code to direct patients first to information they considered more useful than raw pricing data, which also had links on their websites.

Spokeswoman Jane Crawford from Universal Health claimed they were making no efforts to hide any information.

The code was removed from several sites, including HCA, Penn Medicine, and Beaumont.

Many large hospitals and health systems put an embed code on their website to block prices.

Samara Rosenfeld

Articles

Exploring Costs Related to Increased Telehealth Use

Dr. Amy Abernethy Is Leaving FDA

Neil Evans, M.D., Says VHA's "Present and Future Are Bright"

Large Hospitals Blocking Prices on Websites Despite Price Transparency Rule