Department of Defense Telehealth Usage is Concentrated and Limited

Despite a legal mandate that the Department of Defense incorporate telehealth services, usage rate still hovers around 1%.

Many health systems would like to expand their telehealth offerings, but the Department of Defense (DoD) is required to. By June of 2018, the National Defense Authorization Act for Fiscal Year 2017 demands that the agency “incorporate…the use of telehealth services, including mobile health applications,” to provide care, determine diagnoses, and lower costs.

This week, the Government Accountability Office (GAO) released a report on the DoD’s progress. It identifies several key trends, but the most important may be that overall utilization rates of telehealth services in the DoD remain low, and services are concentrated to just a few facilities in the system.

There were 1.2 million active duty military members in 2016. In that year, only about 1% made use of telehealth services: 11,000 received one or more synchronous (real-time) telehealth consultations, while only 2,000 received one or more asynchronous (“store-and-forward”) consultations. The report does not note if there was any crossover between those 2 groups. In total, the GAO report says nearly 60,000 telehealth encounters were facilitated by the DoD in 2016, either through direct or purchased care.

Telehealth was most commonly used to address mental health conditions, which were typically treated through synchronous consultations. Pulmonology-, dermatology-, and cardiology-related conditions were also treated, although more frequently through asynchronous messaging.

Telehealth usage in the DoD is also concentrated. The Army accounted for the vast majority of telehealth services administered across all branches of the military, and about 90% of total synchronous sessions were provided by a group of 5 Army facilities. Brooke Army Medical Center in San Antonio, Texas accounted for more 11,000 telehealth visits alone.

DoD officials explained to GAO that this was “because leaders at these facilities have actively encouraged telehealth use," noting that 4 of the top 7 facilities contain onsite "telebehavioral hubs."

They added that those top facilities "generally have a large number of specialty providers such as pulmonologists who can provide specialty care outside of their facilities through telehealth.”

Authors of the GAO report noted that there may be widespread underreporting of telehealth usage in Army facilities—by as much as 30 percent—which may skew the numbers low.