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Study: Virtual Medical Visits Different for Metro, Nonmetro Patients
Minnesota Ag Connection - 12/05/2018

Telemedicine, or the remote diagnosis and treatment of patients, grew at a rapid pace in Minnesota between 2010 and 2015 with a nearly 7-fold growth in visits jumping from 11,113 in 2010 to 86,238 visits in 2015, according to a new Minnesota Department of Health and University of Minnesota School of Public Health study highlighted in Health Affairs.

In a first-of-its-kind study, health department and School of Public Health researchers joined together to analyze the Minnesota All Payer Claims Database to discover the patterns of telemedicine use in Minnesota between 2010 and 2015.

The research did not look into the effectiveness of telemedicine, but it did find a rapid increase in its use. Tens of thousands of patients received medical care through virtual visits.

Though still a very small slice of Minnesota's health care pie -- less than 1 percent of patients used telemedicine -- the researchers found that telemedicine evolved to serve somewhat different uses for metro-area and Greater Minnesota patients and for those with private or public insurance, such as Medicare, MinnesotaCare and Medical Assistance, Minnesota's Medicaid program.

Nonmetro patients in Greater Minnesota more commonly used telemedicine for real-time visits initiated by providers and included specialty consultations. For example, an emergency department physician may initiate a telemedicine visit with a neurologist for a patient suffering a stroke. Or, a primary care provider may refer a patient to a specialist to provide psychotherapy and medication management for clinical depression.

"This research shows that telemedicine may be emerging as an option to overcome some of the geographical barriers of accessing specialty care in Greater Minnesota, particularly in the area of mental health," said Commissioner of Health Jan Malcolm. "We need more research to ensure quality is being maintained, but this study highlights the importance of seeking innovative ways to provide access to health care in Greater Minnesota, including thinking broadly about funding investments in the health care workforce, as well as technology such as telemedicine equipment and broadband access."

In metropolitan areas, which included the Twin Cities, Rochester, St. Cloud and Duluth areas, the majority of telemedicine services were online evaluation visits for primary care provided by nurse practitioners to patients with commercial insurance. Such "direct-to-consumer" telemedicine visits provide care for common non-emergency conditions, such as the common cold or strep throat.

A greater number of telemedicine users lived in metro areas, however the rate for telemedicine use was higher in nonmetro areas for people with Medicare and Medicaid.

The data also indicate that Minnesota's telemedicine market during the time period was being shaped in part by differences in telemedicine coverage by insurance plans rather than the differing clinical needs of patients. For example, there was very low direct-to-consumer use among Medicaid patients. During the study period, commercial plans increasingly covered patient-initiated online medical evaluations, while Medicare and Medicaid primarily covered the real-time consultations with clinicians.

Minnesota took action to promote telemedicine at the tail end of the study period when it passed the Minnesota Telemedicine Act in 2015. The act requires private insurers and Minnesota Health Care Programs to provide the same coverage for telemedicine as in-person visits. The law also removed requirements for a previous in-person visit and opened up possible service locations, such as allowing telemedicine visits from homes.

"Telemedicine is an important innovation in care delivery," said co-author Jean Abraham, who has a doctorate in public policy and management and is the Wegmiller Professor at the University of Minnesota School of Public Health. "This study provides us with a comprehensive understanding about volume trends, the types of patients obtaining telemedicine services, and the types of providers delivering them. This work provides a valuable foundation for additional research to understand how telemedicine use affects cost, quality and access to care for Minnesotans. "

This group is continuing to analyze telemedicine data in the Minnesota All Payer Claims Database, and is studying the impact of telemedicine visits on follow-up costs, utilization and quality of care. Minnesota's All Payer Claims Database is funded by Minnesota's Health Care Access Fund.

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