Impact of Practice-Level Telehealth on Quality Outcomes in Chronic Care

Practice-level telehealth quality outcomes remained stable for access and preventable hospitalizations among Medicare beneficiaries with chronic conditions during the COVID-19 pandemic. High-adopting primary care practices preserved care continuity while delivering modestly lower performance on select disease-specific quality measures, highlighting the need for stronger support systems around virtual chronic disease management.

Continuity Improves, Select Quality Measures Slip

Practice-level telehealth quality outcomes showed an 8.3 percent relative increase in the Bice-Boxerman continuity index with no rise in preventable emergency department visits or ambulatory care–sensitive hospitalizations. However, beta-blocker prescribing for heart failure dropped by 4 percentage points and blood pressure control rates for hypertension fell by 10 points.

Investigators classified practices as high or low telehealth adopters based on the share of virtual visits from April 2020 to December 2021, then applied a difference-in-differences framework to Medicare claims linked with electronic health record data from three PCORI-funded networks. The approach attributed patients to their pre-pandemic practice, adjusted for demographics, rurality, socioeconomic factors, and clinical complexity, and confirmed parallel pre-pandemic trends.

Policy Signal for Post-2027 Telehealth Rules

These practice-level telehealth quality outcomes supply health economics and outcomes research teams with actionable evidence as Medicare’s telehealth flexibilities near their 2027 expiration. The findings argue for conditioning future coverage on integration with structured remote monitoring and chronic care protocols so that expanded access strengthens rather than erodes outcome performance.

Read the full study in npj Digital Medicine.