Though virtual care and telehealth have garnered plenty of headlines, relatively few Americans are using the modality, according to Trilliant Health's 2022 Telehealth Trends report.  

The analysis, which focused on U.S. telehealth use between March 2020 and November 2021, found 25.6% of Americans accessed care using any type of telehealth (including video, audio-only, chat and other modalities) during this time period. 

Many patients who used telehealth did it sparingly too. Nearly 80% of users had between one and four visits, with 45.7% only accessing one visit. Less than 3% were categorized as "super utilizers," with 25 or more visits during this time frame.

"Our research indicates that patient preferences and many of the prevailing narratives on the market outlook for telehealth are seemingly incongruent, reinforcing caution for organizations that are planning their virtual care strategies solely based on industry hype," Sanjula Jain, Trilliant Health’s chief research officer, senior vice president of market strategy and report author, said in a statement.

"The pandemic absolutely accelerated adoption, but growth is largely attributable to the law of small numbers." 

The report also noted that telehealth use is slowing as the COVID-19 pandemic changes; visits declined 37% in April 2021 from April 2020. 

Providers are seeing the dip too. At the beginning of the pandemic in April 2020, telehealth visits accounted for 59% of care portfolios for early-adopter providers, those who had started using telehealth pre-COVID-19. But by November 2021, the share of telehealth visits had dropped to 36%.

However, there are some bright spots for the modality. From March 2020 to November 2021, behavioral health telehealth utilization as a proportion of the total increased by 55%, from 38.23% to 59.3%. Patients who accessed telehealth visits five or more times were largely receiving behavioral healthcare too. 

Young women are driving utilization. In 2020 and 2021, women made up 58.5% of telehealth patients. They're also more likely to fall into the "super utilizer" category: Some 65% of the group are female, and about 36% are between the ages of 21 and 40. Those heavy users are also concentrated in higher-income counties. 

So what's next for telehealth? The analysis notes there are a variety of companies providing telehealth and digital health tools, including large retailers like Amazon and Walmart. If supply stays steady while demand drops, the price would fall. 

"The reality is that telehealth, which was intended to be a tool to expand access to care, has only managed to do so within a very small subset of the population. More importantly, despite ‘forced adoption’ during the pandemic, telehealth is a commodity good that was not used by the individuals who need it most," Jain said.

"The data suggests that in the absence of alternative choices, telehealth appears to be a substitute good. However, when given a choice, the majority of patients prefer in-person care with the exception of behavioral health. Ultimately, traditional providers are not motivated to adopt telehealth and are not equipped to compete with retail suppliers."