One in six Medicare patients relies on telehealth for medical care beyond mental health

When telehealth flexibilities expanded during the COVID-19 pandemic, most attention focused on mental health - video therapy sessions, psychiatric consultations conducted from living rooms. But a detailed analysis of Medicare data from 2021 to 2023 reveals that the story is considerably broader. One in six Medicare beneficiaries used telehealth during that period, and the majority of those visits were for conditions other than mental health.

The study, published in Annals of Internal Medicine and conducted by researchers from the University of Utah School of Medicine and University of Michigan Medical School, linked outpatient visit data from the nationally representative Medical Expenditure Panel Survey to specific medical conditions and classified each visit as in-person or telehealth. The result is the clearest picture yet of what Medicare telehealth actually looks like across the full range of conditions patients manage.

The scale of non-mental-health telehealth

Mental health visits were indeed the most likely to occur via telehealth - 45.1% of all mental health visits in the study period were conducted virtually. But because non-mental-health conditions collectively involve far more visits, the absolute numbers tell a different story. Approximately 29 million non-mental-health telehealth visits occurred annually among Medicare beneficiaries, covering conditions including diabetes, hypertension, and COVID-19.

This figure - 29 million non-mental-health telehealth visits per year - is what makes proposed rollbacks to non-mental-health telehealth coverage clinically significant. Policies debated in Congress have suggested limiting Medicare telehealth permanence to mental health visits. The data suggest this would disrupt care for millions of older adults managing common chronic conditions through the most convenient and often most accessible channel available to them.

Who relies on telehealth

Medicare beneficiaries are, by definition, older adults - disproportionately affected by chronic disease, mobility limitations, and geographic distance from specialists. For these populations, telehealth is not a convenience but often a necessity. A patient with severe arthritis who cannot drive long distances for a routine diabetes management visit is not substituting telehealth for an equivalent in-person experience - telehealth may be the only realistic option for maintaining regular clinical contact.

The authors warn that rolling back telehealth flexibilities may reduce access and strain health systems already facing high demand for in-person appointments. When telehealth visits disappear, some patients cancel appointments entirely; others add to waiting lists for in-person slots.

A separate finding: updated VA/DoD asthma guidelines

The same issue of Annals of Internal Medicine publishes an updated joint clinical guideline from the Department of Veterans Affairs and Department of Defense on asthma management. The updated guideline, developed through systematic review of evidence published between July 2018 and May 2024, endorses inhaled corticosteroids (ICS) - alone or paired with a rapid-onset long-acting beta-agonist - as the cornerstone of treatment. Notably, the guideline finds that indoor air filtration devices show little benefit for asthma control, reversing assumptions some patients and clinicians have held about air quality interventions.

The guidelines also confirm that addressing comorbid conditions like GERD and obesity can improve asthma control, and provide clearer criteria for when primary care providers should refer to specialists.

What the telehealth data cannot address

The analysis describes utilization patterns but cannot directly compare clinical outcomes between telehealth and in-person visits for the same conditions. Whether chronic disease outcomes - blood sugar control, blood pressure management - are as good via telehealth as in person remains an open question for specific conditions and populations. The telehealth expansion also occurred during a period of major healthcare disruption, so some utilization patterns may reflect pandemic-era circumstances rather than stable long-term behavior.