Non-COVID-related care is down across the country. Treatment in urgent care centers is up. There are more new industry entrants than ever before. And, just in case you needed a reminder, the healthcare status quo is no longer. Those are among findings in the second annual installment of Trilliant Health’s “Trends Shaping the Health Economy” series, released last week. 

Also among the 110 data-driven analyses and 13 macro trends elucidated in the report are four… let’s call them countertrends. All reflect popular beliefs that emerged during the post-pandemic era, but don’t exactly hold up to scrutiny.. 

Per Trilliant: Its conclusions are “grounded in facts,” often from deidentified Medicare claims or consumer datasets, and its projections are based on machine learning “with minimal reliance on survey data.”

1. Telehealth super-utilizers 

The first myth exploded by the report is that a group of “super-utilizers” is somehow dominating telehealth. In reality, it’s the one-time samplers driving the medium’s use, data show. 

The findings point to the danger of putting too much stock in pandemic-era estimates of telehealth’s popularity. In retrospect, most people were never all-in on seeing their clinicians via Zoom: Almost half of telehealth patients (48.7%) used the service only once in 2021, per Trilliant. 

Annual utilization patterns show another 32% had between two and four visits. Just 6% of telehealth patients qualified as “average utilizers” using it for between five and six visits, while less than 3% fell into the “super-utilizer” category of having 25 or more telehealth visits in the same time frame. 

Meanwhile, demand for digital medicine continues to track below its pandemic peak. Trilliant pegs the dropoff at 37%, based on its all-payer claims database. Visit volume peaked at 73.7 million in Q2 2020; visits in Q1 2022 totaled 46.4 million. The dip “suggests that expanded availability of virtual care options has not shifted widespread consumer preferences,” per the report.

Two age groups that have proven to be a drag on those usage rates are seniors and children. Analysis of their usage reveals declines of 9.3% and 27.9%, respectively, between January 2020-March 2021 and the January 2021-March 2022 periods.

2. Telehealth minimizes provider shortage

A related misperception: that telehealth scale is helping overcome the provider shortfall. Nearly one in 10 physicians (9.8%) retired over the last three years due to the “pandemic effect” and long-standing burnout, Trilliant noted. Meanwhile, out of all office-based M.D.s and D.O.s in the U.S. (a number Trilliant estimated to be around 600,285), 7.8% were just starting out in practice.

In other words, the period from 2019 to 2022 saw a 2% workforce reduction. 

It was thought that telehealth could ease some of those supply challenges. Yet after an initial burst early in the pandemic, the number of entities billing for telehealth has continued to dwindle.

The number shot up from 20,000 at the end of 2019 to 175,000 in Q1 2020, claims data indicate. But it’s been all downhill from there, with the number of billing entities plummeting to 145,000 in Q1 2022, a 19.5% decrease. 

“While many aspects of telehealth were touted to in part provide more scale to physicians (as a way to minimize the supply shortage), the data suggests otherwise,” the report noted.

3. Omnichannel patients 

How often have you heard someone opine that patients are connecting with providers in multiple channels, and that industry needs to follow them across those different channels as it tracks the healthcare journey? 

As the data show, “the omnichannel patient” is a real phenomenon, but perhaps not to the extent many may have thought. “The pandemic revealed patient preferences for omnichannel care,” the report observed. But for all the attention paid to those other channels, more patients are returning to solely in-person care.

The proportion of patients in virtual-only or hybrid arrangements peaked in 2020 at 3.3% and 25.3%, respectively. They then declined to 2.9% and 20.1% last year; this year, it’s 4.2% and 14.8%.

According to Trilliant, in-person care may be a bigger winner than could have been expected at the pandemic’s outset. Eighty-one percent of patients have opted for brick-and-mortar visits this year, up from 77% in 2021 and 71.4% in 2020.

So while the idea of the omnichannel patient may have reached near-mythological proportions, the patterns above suggest otherwise. That said, one channel for which pharma marketers will need to account is telehealth-enabled prescribing. In 2020 and 2021, roughly 35% of antidepressants and antianxiety drug prescriptions were associated with a telehealth visit, versus just 1% in 2019.

4. The return of “normal” care

Another belief that the Trilliant data turn on its head is that, as clinics have reopened and elective surgeries kick back in, the healthcare system has transitioned back to “normal.”  It’s more that non-COVID healthcare volume has fallen off a cliff, and that drop has been overshadowed by COVID-19 treatment. 

According to Trilliant, pandemic-era care Is “foregone rather than delayed.” That is, while urgent care volumes were 31% higher in Q1 2022 than in Q1 2019, the increase is largely due to COVID-19 testing and treatment. 

Healthcare utilization is actually down, because COVID-19-related care (testing, treatment and vaccination) is “driving the appearance of a post-pandemic return to care,” as the report put it. Indeed, when COVID-19 is left out, behavioral health volumes are up 16.8% from Q1 2019, while all other healthcare encounters are down by 6.2%. 

Nor have patients returned to pre-pandemic care patterns. Between January 2018 and December 2019, 96% of adults had at least one encounter with the healthcare system. Among that population, claims data cited by Trilliant show, only 89% have returned to normal care in 2021 and only 43% have returned solely to care that is unrelated to COVID-19.

To be sure, the average patient is interacting with the healthcare system in a different way. Pre-pandemic, a patient’s primary touchpoint with the healthcare system may have been their annual wellness visit with an established provider.

Their new post-pandemic reality may be delayed care or an urgent-care visit. Outpatient procedures are being replaced by inpatient ones and office-based visits are often being supplanted with telehealth therapy.

That said, COVID-care, masquerading as return-to-care, is masking a big volume dropoff. Think about that the next time someone starts lecturing you about “the great reopening.”