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Telehealth

Background

Last updated: 8/27/2025

Issue:  Telemedicine refers to the remote delivery of clinical health services through the use of information and communication technologies. Telehealth is a broader concept that encompasses telemedicine as well as other activities, including: (1) remote patient monitoring; (2) virtual patient education; and (3) store-and-forward technologies, which allow for the asynchronous transmission of patient information, such as medical images or clinical notes, from one provider to another without requiring simultaneous presence.

Telehealth offers both advantages and disadvantages relative to in-person care. Potential benefits include:

Greater convenience;
Expanded access to care, particularly in rural or underserved areas and for individuals with limited mobility;
Reduced transmission of infectious diseases;
Potential cost savings.

However, telehealth also presents certain challenges, including:

Reduced continuity of care;
Weakened provider-patient relationships;
Risk of inappropriate utilization due to misaligned financial incentives and other systemic issues.

The impact of telehealth on overall health care spending is mixed. Although some telehealth services may appear cost-saving, they do not necessarily reduce total expenditures. This is due to the complex interrelationships among different levels of care, including primary, specialty, and advanced services. If telehealth leads to increased fragmentation of care or replaces continuous primary care with episodic encounters from new providers, patients may subsequently require more specialized or intensive care. Such dynamics could ultimately result in higher overall health care spending.

Between 2020 and 2025, telehealth utilization in the United States experienced a dramatic surge followed by gradual stabilization. At the height of the COVID-19 pandemic in mid-2020, more than 50% of occurred virtually, and soared from 15.4% in 2019 to 85.9% in 2021. During 2021, 37% of U.S. adults used telemedicine, with mental health services comprising about 40% of telehealth visits. rose sharply, from 0.1% of Physician Fee Schedule spending pre-pandemic to over 16% in April 2020, before settling at 5% for the full year. In 2022, to 30.1% of adults, though 66.3% of physicians still used video visits, and remote patient monitoring grew to 21.5%. From 2023 onward, persisted at moderate levels: about 25% of Medicare fee-for-service beneficiaries received telehealth services annually, and 96% of HRSA-funded health centers continued offering primary care via telehealth. These figures reflect lasting integration of telehealth into care delivery, even as peak pandemic-era use receded.

��첵��ǳܲԻ�:  Telehealth services in the U.S. date back to the 1960s. This is when the U.S. government, through agencies such as the National Aeronautics and Space Administration (NASA) and the Department of Defense (DOD), began exploring the use of telemedicine to provide health care consultations to astronauts and military personnel stationed in remote locations.

As technological advances continued over the decades, telehealth improved and expanded. By the 2000s, telehealth became more common in certain specialties, such as radiology, dermatology, and pathology. Throughout the 2010s, telehealth gained momentum with the proliferation of smartphones, high-speed internet, and mobile apps. As such, the use of telehealth began to expand beyond specialty care to include primary care, mental health services, and remote patient monitoring. In parallel, many states introduced specific regulatory measures to facilitate telehealth adoption. These included cross-state licensure compacts (e.g., the Interstate Medical Licensure Compact), parity laws requiring private insurers to reimburse telehealth services at levels comparable to in-person care, and expanded Medicaid coverage for a broader range of telehealth modalities. At the federal level, Medicare gradually extended coverage to include telehealth services for beneficiaries in rural areas, as well as for certain behavioral health and chronic care management needs. Additionally, the Health Resources and Services Administration (HRSA) funded telehealth resource centers to support provider adoption and best practices. These targeted policy interventions, combined with sustained technological advancements, helped normalize telehealth delivery in both public and private health care systems, shaping long-term changes in provider workflows, patient engagement, and system-level cost structures.

Despite these incremental advancements, broad adoption of telehealth remained constrained prior to the COVID-19 public health emergency (PHE). Many government and private payers telemedicine and other telehealth services. They were concerned that the ease of access provided by telehealth would increase health care utilization overall, which would likely increase spending. For years, Medicare visit was about one-third less than the payment for a standard in-person visit. Medicare only covered telemedicine visits for a few select situations. Most other payers followed Medicare’s coverage and payment rules. based on where the patient was located, where the physician was licensed, and the type of technology used.

Changes to telehealth payment and coverage rules, starting in early 2020, aimed to limit the spread of infectious disease, expand access to health care, and ensure the solvency of medical practices. Changes implemented by private and public payers paved the way for dramatically higher use of telehealth services. Medicare coverage and payment rules were temporarily relaxed or removed; telemedicine visits were covered for all Medicare beneficiaries and paid at the same rate as in-person visits.  coverage and availability of telehealth services by passing legislation and enacting regulations requiring coverage and payment parity for telehealth and allowing interstate licensure agreements. Some health care plans waived telehealth copays for the duration of the PHE. The �Ӱ��Ƶ tracked state actions in this area and other pandemic-related issues and made the information publicly available on its website .

As health care continues to transition following the COVID-19 PHE,  and  have expressed interest in maintaining the increased availability of telehealth services. Health care spending and health insurance premiums could increase if the total number of physician visits or intensity of services increases due to the sustained uptake of telehealth services.

While the potential benefits of increased telehealth have been well publicized, it is important to also consider the potential negative effects of these developments on patients and consumers, including:

Care coordination, continuity of care, doctor-patient relationship, and trust may deteriorate if telemedicine visits with new providers replace telemedicine or in-person visits with patients’ established providers. . Receiving primary care from one’s established primary caregiver is strongly associated with improved health and . The , , and ) have stated that responsible use of telemedicine should happen in consultation with a physician who has an established relationship with the patient.
Telehealth services aimed at direct-to-consumer marketing of prescription medications may leave patients confused and misinformed. It may also erode primary care coordination. In addition, telehealth companies must ensure about prescribing procedures are in place for controlled substances and other medications that may cause harm or addiction.
Telehealth startups’ practices of sharing data with big tech companies may pose to patients.

Physician membership organizations have expressed a strong desire for regulations and payments supporting telehealth to become permanent. Likewise, the telehealth market has grown dramatically. However, there are few studies that measure the impact of these changes on crucial health care outcomes like quality, usage, and costs. The Medicare Payment Advisory Commission (MedPAC) continues to because of uncertainties about the impact on quality and spending.

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Status: The focus on telehealth has increased dramatically since the beginning of 2020, and many organizations—including the , , and —strongly urge that regulations and payments favorable to telehealth be made permanent. Telehealth startups and venture capital focused on telehealth opportunities have .

Telehealth use has declined and stabilized since its peak during the COVID-19 PHE. Use remains much higher than before the pandemic; compared with about 1% in February 2020. The portion of visits provided via telemedicine varies by specialty. By the last half of 2022, about half of behavioral health visits were provided virtually.

The �Ӱ��Ƶ’s Health Insurance and Managed Care (B) Committee, its subcommittees and working groups, and state insurance regulators continue to closely monitor telehealth developments to protect consumers and promote equitable access to care.

The Special (EX) Committee on Race and Insurance charged the Health Innovations (B) Working Group with evaluating mechanisms to reduce disparities through a few different means, including telehealth services and alternative payment models. Key findings of the research include that telehealth has the potential to bridge the gap in access to care by connecting isolated people with culturally competent health practitioners while reducing the need for transportation to receive such care.

Whether telemedicine primary care visits are with patients’ significantly impacts health outcomes in primary care and beyond. If increased telemedicine visits with new providers result in fewer visits with patients’ established primary care providers, it could negatively affect the doctor-patient relationship. This could potentially leave patients worse off.