Though telehealth usage has declined from pandemic highs, the forces of consumerization and pressure from new retail companies could have a growing impact on the healthcare industry, according to a report by Trilliant Health. 

The 2022 Trends Shaping the Health Economy analysis found that telehealth volumes peaked at 73.7 million visits in the second quarter of 2020 and that visits during the first quarter of this year reached 46.4 million.

Meanwhile, nearly half of telehealth patients only had one visit in 2021. About 80% of patients had between one and four visits last year. Behavioral health continues to be a significant use case for telehealth, making up nearly 60% of visits during Q1 2022. In comparison, more than 32% of telehealth visits were for behavioral health reasons during the first quarter in 2019.

Prescribing via telehealth has also grown compared with the pre-pandemic era. According to the report, about 35% of antidepressants and anti-anxiety medications were associated with a telehealth visit in 2021 and 2020, compared with only 1% in 2019.

Just over 28% of thyroid agent prescriptions were enabled by telehealth in 2021, compared with more than 31% in 2020 and just 0.5% in 2019. More than a quarter of statins were prescribed via telehealth last year, compared with 0.4% in 2019.

Though telehealth use has declined from the early days of the COVID-19 pandemic, the report notes traditional providers are facing increased competition from newer entrants, like CVS Health, Walgreens, Walmart and Amazon.

As patients with higher deductibles are on the hook for a larger portion of their healthcare costs, these retail players could provide more attractive options, particularly for low-acuity services. For example, the report found a lipid panel would cost $37 at CVS, $35 at Walgreens, $10 at Walmart and $102 at an urgent care center.

Walmart has a huge physical presence in the U.S., including in underserved and rural areas. Though Amazon revealed its plans to shut down its Amazon Care service this year, the report noted many markets overlapped between the service and One Medical, which the tech and retail giant has recently signed an agreement to acquire.

"For decades, commercially insured patients have been the lifeblood of the health economy, and the secular decline in the percentage of that group is detrimental for every health economy stakeholder. Additionally, Americans have been slow to return to primary care and preventive screenings post-pandemic, and many of those who have returned are choosing urgent care and retail clinics in lieu of traditional primary care providers," Trilliant Health CEO Hal Andrews said in a statement.

"As leading retailers and payers begin to commoditize low-acuity services and the Congressional Budget Office analyzes the effect of price caps on medical reimbursement, the business model of every health economy stakeholder is pressured."