AJMC Studies Explore the Pandemic's Impact on Telehealth, Care Access, and Patient Experience

March 11, 2025, marked 5 years since the World Health Organization (WHO) declared COVID-19 a pandemic. Between January 22, 2020, and March 10, 2023, Johns Hopkins University recorded over 676 million confirmed COVID-19 cases worldwide and more than 6.8 million related deaths.1 In the US alone, more than 103 million cases and over 1 million deaths were reported during this timeframe.

The COVID-19 pandemic reshaped the health care landscape, accelerating shifts in care delivery. As highlighted in studies published in The American Journal of Managed Care®, it led to a surge in telehealth utilization. However, other studies found that, despite these advancements, persistent care access challenges remain, particularly for vulnerable populations.

These studies published in The American Journal of Managed Care® explored telehealth, care access, and patient experience during the COVID-19 pandemic. | Image Credit: Production Perig - stock.adobe.com

Telemedicine Expansion During the COVID-19 Pandemic

One study, titled “Telemedicine Catches On: Changes in the Utilization of Telemedicine Services During the COVID-19 Pandemic,” examined telemedicine expansion, both overall and across various patient subpopulations and diagnoses.2 Despite the disruptive effects of the COVID-19 pandemic, the researchers hypothesized that telemedicine visits would significantly increase due to the need for continuous care.

To test this hypothesis, they analyzed health insurance claims for telemedicine visits during the prepandemic (January 1, 2018, through March 10, 2020) and pandemic (March 11, 2020, through October 31, 2020) periods. The study included claims from 1,589,777 telemedicine visits submitted to Independence Blue Cross, covering both telemedicine-only providers and those traditionally offering in-person care.

The primary exposures included state stay-at-home orders, individual behavior changes, and Independence Blue Cross's expansion of telemedicine billing policies. Also, the comparison group was telemedicine visits during the prepandemic period.

Telemedicine visits increased rapidly, from a mean (SD) of 773 (155) weekly visits during the prepandemic period to 45,632 (19,937) weekly visits during the pandemic period. Compared with the prepandemic period, a greater proportion of telemedicine users during the pandemic were older, had Medicare Advantage insurance plans, had existing chronic conditions, or resided in predominantly non-Hispanic Black or African American census tracts. Additionally, there was a significant rise in telemedicine claims involving mental health-related diagnoses.

The researchers concluded that the trends suggest telemedicine will play a key role in postpandemic care delivery and called for further research on the subject.

“As the future of telemedicine evolves, continued research into adoption trends, health outcomes, and patient and provider satisfaction will be needed to set policy and guidelines for safe and effective use of this technology,” the authors concluded.

Persistent Barriers to Health Care Access During the Pandemic

While telehealth expanded rapidly, it was not a universal solution. Many patients still struggled to access care, as explored in the study, “Inability to Access Health Care Due to COVID-19 Among Medicare Beneficiaries.”3

The researchers noted the limited understanding of the factors associated with the inability to access health care services because of the COVID-19 pandemic. To address this, they conducted a cross-sectional study to examine these factors among Medicare beneficiaries.

The researchers analyzed data from the summer and fall 2020 Medicare Current Beneficiary Survey COVID-19 Rapid Response supplement Questionnaire. Their study population included community-dwelling Medicare beneficiaries aged 65 and older (summer: n = 8751; fall: n = 7421).

The findings demonstrated that about 20.9% of beneficiaries in summer 2020 and 7.5% in fall 2020 reported being unable to access health care services due to the pandemic. The most frequently reported inaccessible services were regular check-ups (summer, 35.9%; fall, 35.1%) and dental care (summer, 45.5%; fall, 35.1%).

Additionally, beneficiaries with an income of $25,000 or more and those who spoke English at home were more likely to report being unable to access services than their counterparts. Lastly, beneficiaries with at least 4 chronic conditions were significantly more likely to experience care access barriers than those with 1 or no conditions.

“...these findings can allow decision makers to target resource allocation and outreach efforts to those populations most at risk,” the authors concluded.

Shifts in Care Delivery, Patient Experience During the Pandemic

Amid the surge in telehealth utilization and ongoing issues with care access, the study, “Patient Experience After Modifying Visit Delivery During the COVID-19 Pandemic,” explored real-time changes in medical visits, visit modes, and patient-reported visit experience associated with the rapid reorganization of care during the COVID-19 pandemic.4

The researchers explained that, in response to public health and clinical guidance, team-based structural changes were implemented in Kaiser Permanente Mid-Atlantic States (KPMAS), a large, integrated health system. These changes aimed to transition care delivery from office-based visits to virtual care platforms.

To measure the impact of these changes, KPMAS reported overall and discipline-specific weekly medical visits, visit modes (office-based, telephone, or video), and associated aggregate measures of patient-reported visit experience.

Therefore, the researchers conducted a 38-week cross-sectional time series analysis from September 29, 2019, through June 20, 2020, with interruptions on March 8, 2020, and May 3, 2020.

After the first interruption, they observed a decrease in the weekly trend for all visits (β3 = –388.94; P < .05) and an immediate decline in office-based visits (β2 = –25,175.16; P < .01). In contrast, telephone-based (β2 = 17,179.60; P < .01) and video-based visits (β3 = 282.02; P < .01) increased.

Following the second interruption, the researchers noted an increase in long-term weekly visit trends for all visits (β5 = 565.76; P < .01), a rise in video-based visits (β4 = 3523.79; P < .05), and a continued increase in office-based visits (β5 = 998.13; P < .01). However, video-based visits showed a declining trend over time (β5 = –360.22; P < .01).

Additionally, they observed increased long-term trends in patient satisfaction, with patients reporting "excellent" experiences for all visit types (β5 = 0.17; P < .01), telephone-based visits (β5 = 0.34; P < .01), and video-based visits (β5 = 0.32; P < .01). Notably, video-based visits had the highest proportion of respondents rating their scheduling experience and visit as “excellent.”

The researchers concluded by expressing confidence in their findings and outlining potential areas for future research.

“This report informs further investigation and dialogue that should assist in formulating best practices in preparation for future emergencies…” the authors concluded. “Additionally, this report should inform future public policy debates involving the structural and financial considerations necessary to manage practice transformation during both pandemic and nonpandemic times.”

References

1. COVID-19 dashboard. Johns Hopkins Coronavirus Resource Center. Updated March 10, 2023. Accessed March 14, 2025. https://coronavirus.jhu.edu/map.html
2. Friedman AB, Gervasi S, Song H, et al. Telemedicine catches on: changes in the utilization of telemedicine services during the COVID-19 pandemic. Am J Manag Care. 2022;28(1):e1-e6. doi:10.37765/ajmc.2022.88771
3. Park C, Ng BP, Kim K. Inability to access health care due to COVID-19 among Medicare beneficiaries. Am J Manag Care. 2022;28(2):75-80. doi:10.37765/ajmc.2022.88823
4. Miller MJ, Watson ES, Horberg MA, Bhatia M, Tripuraneni BR, McCarthy RJ. Patient experience after modifying visit delivery during the COVID-19 pandemic. Am J Manag Care. 2021;27(2):e54-e63. doi:10.37765/ajmc.2021.88535