The COVID-19 pandemic drove unprecedented growth in telehealth visits as patients sought ways to safely access healthcare.

UnitedHealth Group reports that telehealth visits among UnitedHealthcare members grew from 1.2 million in 2019 to almost 34 million in 2020. Among Optum patients, telehealth visits grew from 1,000 in 2019 to 1.3 million in 2020.

“As far back as I can remember, this is probably one of the most dramatic changes in the practice of medicine, definitely over a generation,” said Margaret-Mary Wilson, M.D., UnitedHealth Group’s chief medical officer, during a recent media briefing.

UnitedHealth Group data show that telehealth growth has slowed in the past year. “But there is increased stickiness, and many of those new telehealth users are now repeat telehealth users,” Wilson said.

At the end of 2020, half of UnitedHealthcare members leveraging telehealth visits were repeat users, she said. Through July 2021, virtual care visits among health plan members totaled 18 million, representing 2,700% growth compared to the same time frame pre-pandemic.

“We are leaning into telehealth to be a connection point by fostering connectedness between the patient and healthcare provider team,” Wilson said.

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UnitedHealth Group is taking lessons learned during the COVID-19 pandemic to leverage telehealth as part of its strategy to address health inequity, particularly for vulnerable and underserved communities, she noted.

“Viewed through a population health and health equity lens, we actually view virtual care as a game changer,” Wilson said.

“A lot of work has been done and there is more work in progress, but there’s still so much more we need to do. The end goal is taking care to the person as opposed to expecting the person to battle through barriers to get to care. We’re working to make that happen for the people that we serve,” she said.

Tackling technology and access barriers

Patients who struggle to access traditional, in-person care often face barriers to accessing virtual care as well because they can’t afford broadband internet or have older devices that can’t support telehealth platforms.

“We realized early on that many of our most vulnerable patients were unable or reluctant to use traditional telehealth,” said Daniel Frank, M.D., chief medical officer at Optum Care, the healthcare provider arm of Optum.

“We recognized these challenges and engaged these patients with chronic conditions or those who had missed recommended care and offered them pre-data-loaded devices, a tablet connected to a cellular provider’s network to enable virtual care for these members,” Frank said.

Since April 2020, providers at WellMed have treated more than 200,000 patients through the use of these tablets. Part of Optum, WellMed is a network of doctors, specialists and professionals providing care for older adults with offices in Texas and Florida.

Of those 200,000 visits, 40,000 patients became repeat users of the program, Frank said.

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“The tablets provide a simplified interface tailored to the physiology of our higher-risk and older patients—brighter screens, larger icons—and their electro-sensitivity is optimized for thinner skins,” he said.

To date, the program has been expanded to 94 primary care practice sites across Optum Care.

About one-third of Optum Care’s patients have unmet social needs, Frank noted.

“Right now, when we identify a need, we are able to address it 60% of the time. Programs like these are going to be real game changers and really establish a new standard of care,” he said.

It’s become clear during the course of the pandemic that virtual care has provided a lifeline to patients with behavioral health issues.

Within Optum’s behavioral health services, virtual visits increased patient appointments by 130% above the pre-pandemic baseline. And the company reports there was a 200% increase in appointments among members enrolled in Medicaid.

“This is a concrete example of how we can use technology at a national scale to sidestep significant social, economic and geographic barriers to enable people to access care,” said Catherine Anderson, senior vice president of strategy, UnitedHealthcare Community & State, during the briefing.

One in 5 U.S. adults, around 61 million people, are affected by a mental health or substance use disorder, and less than half get appropriate care, she said. Forty percent of Americans live in areas with a shortage of behavioral health providers, and this is exacerbated for people served by Medicaid due to geographic factors, provider shortages and social determinants of health.

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Anderson acknowledged there are still significant gaps that need to be closed for virtual care to “realize its potential.”

“Medicaid beneficiary use of telehealth remains far behind people with other coverage. Only 34% of Medicaid claims are for telehealth compared to 60% for commercial and 44% for Medicare Advantage, she said.

She added, “I would suspect as people become more familiar and comfortable with the technology and they understand the value of the relationship they are creating that we are going to see that increase, particularly in the Medicaid space,” she said.

Ramping up investments in virtual care

In October, UnitedHealthcare unveiled a new virtual-first plan design called NavigateNOW, which was developed in collaboration with Optum.

Members can connect 24/7 with a personalized Optum care team that will assist with primary care, urgent care and behavioral health care services as well as UnitedHealthcare’s national provider network. Members will also have $0 copayments on a slew of services, including both in-person and virtual primary care and behavioral health care, virtual urgent care and many generic medications.

The company continues to explore the best ways to use virtual care and what health conditions are most amenable to being treated via telehealth, Frank said.

“Transparently, we’re all still in a learning mode. How much care can be delivered virtual and what is the ‘optimal’ level of that, that is going to be, in my opinion, as much dictated by data and science as it is going to be about the human experience and what our patients want,” he said during the briefing.

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