Congenital heart defect (CHD)-related telehealth and other outpatient utilization among Medicaid and private insurance beneficiaries: 2018–2023

Introduction Accessing specialty cardiac care presents challenges for U.S. individuals with congenital heart defects (CHD), despite recommendations for regular cardiac follow-up. Additionally, the impact of the COVID-19 pandemic and telehealth expansion on CHD-related health care is not well-understood. Therefore, our objective was to evaluate changes in CHD-related telehealth and other outpatient utilization in the Medicaid population from 2018 to 2022 and a privately-insured population from 2018 to 2023. Methods Using claims from national Medicaid (2018–2022) and private insurance (2018–2023) databases, we calculated the number of CHD-related outpatient encounters per 100,000 enrolled children or adults and the number conducted via telehealth. We compared CHD-related outpatient utilization trends before and after the COVID-19 interruption (identified as March–May 2020) as an interrupted times series with Poisson regression. Results Among adults and children in both insured populations, CHD-related outpatient utilization increased before the COVID-19 interruption (January 2018–February 2020); afterward, it decreased in Medicaid but continued increasing at a slower rate among the privately-insured (all P < 0.01). For children, CHD-related outpatient utilization in June 2020 was lower (8%–Medicaid, 5%–private) than would be expected without the interruption (both P < 0.01). Though <1% pre-pandemic, recent (2022/2023) telehealth utilization accounted for 1%–4% of pediatric and adult outpatient CHD-related encounters in both databases. Discussion CHD-related outpatient care has declined among Medicaid beneficiaries and slowed among private insurance beneficiaries since the COVID-19 interruption, and efforts may be needed to re-engage CHD patients in regular outpatient cardiac care. Telehealth may be an underutilized option to improve access to CHD care.