Trends in Telehealth Use During the COVID-19 Pandemic

Medicare telehealth utilization measured as visits per thousand beneficiaries peaked in April 2020 early in the pandemic and gradually declined through November 2020. Telehealth utilization has been substantially higher for high-need, high-cost beneficiaries (defined below) but utilization for these beneficiaries has also declined over time.

telehealth visits chart

On average, Medicare beneficiaries that were attributed to ACOs received telehealth services at about the same rate as those not assigned to ACOs (data not shown). But there is substantial variation in telehealth utilization across different ACOs as shown below (percentile values area indicated by orange lines).

iac monthly insights

The top 10 percent of ACOs based on Medicare telehealth utilization provided about twice as many telehealth visits per beneficiary compared with the ACO average. What are the characteristics of these high performers relative to ACOs as a whole? They are much more likely to be physician-run (76% vs. 50%), smaller (12,800 vs. 20,000), and concentrated in six states (CA, FL, MI, NJ, NY, TX account for 88%). The same proportion (27%) participated in a Track qualifying as an advanced APM in 2019.

Note: This analysis was conducted by the Institute for Accountable Care using monthly Medicare claims data from the CMS Virtual Research Data Center representing approximately 28 million Medicare beneficiaries.


  1. Medicare assignable beneficiaries are any beneficiary with at least one evaluation and management visit during the 12-month period studied.
  2. High-need, high-cost beneficiaries were defined as beneficiaries with at least one inpatient hospitalization, one SNF stay of at least 14 days, or three emergency department visits in 2019 with at least one of the following diagnoses: CHF, COPD, Alzheimer’s, Atrial Fibrillation, Chronic Kidney Disease.