Telehealth Utilization Among Children with Autism Spectrum Disorder in Employer-Sponsored Plans, 2019–2022

OBJECTIVES: The COVID-19 pandemic disrupted in-person outpatient services, which was partially offset by telehealth utilization. The study examined how the uptake of therapies for privately-insured children with autism spectrum disorder (ASD) changed during the pandemic.

METHODS: Using 2019 to 2022 MarketScan® Commercial claims data, we identified children aged 3‒17 years with current-year ASD diagnoses (≥2 claims with ASD ICD-10 codes in a calendar year) enrolled in employer-sponsored plans. Telehealth encounters (claims on unique days) among children with ASD diagnoses were identified by place of service and telehealth-related procedure modifiers; all other encounters were classified as in-person. We used 60 procedure codes to identify behavioral health encounters. We calculated monthly percentages of children with ASD diagnoses who had telehealth and in-person outpatient encounters from January 2019 through May 2022, both overall and behavioral health-related.

RESULTS: Between February and May 2020, the percentage of children aged 3‒17 years with current-year ASD diagnoses having in-person outpatient visits decreased from 99.0% to 36.8%, while the percentage with telehealth visits increased from 1.0% to 63.2%. In-person encounters per child decreased from 4.3 to 3.5, while telehealth encounters increased from 0.01 to 1.5; total encounters increased from 4.4 to 5.0. Although the mean number of per-child outpatient telehealth encounters subsequently decreased to 0.5 in May 2022, overall per-child outpatient encounters remained steady, 5.2 visits in May 2022. Telehealth behavioral health encounters per child increased from zero to 0.8 in May 2020 before falling to 0.2 in May 2022; overall per-child behavioral encounters increased from 2.4 in February 2020 to 2.7 in May 2020 and 2.8 in May 2022.

CONCLUSIONS: Telehealth use for privately insured children with ASD surged in the initial months of the pandemic, both overall and for behavioral health encounters, resulting on average in increases in overall and behavioral outpatient encounters for children in participating plans.