Telehealth's Evolution: A Comprehensive Analysis of Usage Trends

An Analytical Review of Virtual Care’s New Normal

By Elena Pak, Credentialing Department, WCH

The COVID-19 pandemic fundamentally disrupted how Americans access healthcare. Within weeks of the March 2020 public health emergency declaration, telehealth visits surged from a marginal share of clinical encounters to a dominant mode of care delivery. Hospitals, primary care practices, and specialty clinics pivoted overnight to video consultations, phone visits, and asynchronous messaging. Policymakers responded with sweeping regulatory and reimbursement flexibilities, temporarily dismantling longstanding barriers to virtual care.

Now, nearly six years later, a comprehensive new analysis from Epic Research offers the clearest large-scale picture yet of where telehealth has settled in primary care — and the answer is more nuanced than either telehealth optimists or skeptics might expect. The data, drawn from over 400 million primary care visits between July 2022 and October 2025, tells a story of post-pandemic normalization: a technology that survived the end of the emergency, found its footing, and now occupies a stable but modest share of the primary care landscape. Understanding this stabilization — its causes, its contours, and its implications — is essential for healthcare executives, policymakers, and clinicians navigating an evolving care delivery environment.

The Arc of Telehealth Adoption: Boom, Correction, and Stabilization

To appreciate where telehealth stands today, it is worth tracing the full arc of its adoption curve. Prior to the pandemic, telehealth accounted for a negligible fraction of outpatient visits — roughly 0.1% of Medicare primary care encounters in 2016, according to federal health data. The technology existed, but regulatory restrictions, reimbursement limitations, and cultural inertia kept it firmly at the margins.

The pandemic changed everything. In the second quarter of 2020, telehealth visits spiked by over 4,000% compared to the same period in 2019, according to the Centers for Disease Control and Prevention. This explosive growth was facilitated by emergency waivers that expanded Medicare and Medicaid coverage for virtual visits, eliminated geographic restrictions that had previously limited telehealth to rural areas, permitted audio-only consultations, and relaxed licensing requirements across state lines.

By mid-2022, however, the peak had passed. Epic Research’s analysis shows that telehealth accounted for just over 8% of primary care encounters in July 2022 — already well below pandemic highs, but still historically elevated. What followed was a gradual but meaningful decline: by October 2025, telehealth’s share had dropped to just under 6% of primary care visits, representing roughly a 30% reduction from that mid-2022 benchmark.

Yet the more significant finding is what happened after 2023: telehealth utilization stopped declining. Since then, the share of virtual visits in primary care has held relatively steady at between 6% and 7%. This plateauing behavior is analytically important. It suggests that the sector has reached something approaching a structural equilibrium — a point at which the convenience of telehealth for certain patients and use cases is balanced by the clinical limitations and preferences that pull others toward in-person care.

Who Is Using Telehealth — and Who Is Not

The aggregate figure of roughly 6% to 7% of primary care visits obscures substantial variation across demographic and geographic groups. This heterogeneity is arguably the most policy-relevant aspect of the Epic Research findings, as it reveals both the populations where telehealth is successfully embedding itself and those where access barriers persist.

Geography: The Urban-Rural Divide Persists — But in a Counterintuitive Direction

One of the most striking findings in the Epic analysis is that telehealth utilization is consistently about twice as high in metropolitan areas compared to rural communities. This runs counter to a dominant policy narrative that positioned telehealth as a solution to rural healthcare access problems. Advocates have long argued that patients in rural areas, who often face long driving distances to see a primary care provider, stood to benefit most from virtual care.

The data suggests that while this logic holds in theory, significant structural barriers undermine telehealth adoption in rural settings in practice. Limited access to high-speed broadband internet remains a serious impediment: as of 2023, approximately 19% of rural Americans lacked access to fixed broadband that meets minimum speed thresholds. Beyond connectivity, rural hospitals and practices have faced financial challenges in building out telehealth infrastructure, and the population demographics of rural communities — generally older, with lower digital literacy — further dampen utilization.

This is not to say telehealth cannot serve rural patients effectively. Targeted investments in connectivity and digital literacy programs, combined with appropriate reimbursement structures, could shift the equation. But the current data suggests that without deliberate intervention, telehealth’s convenience benefits are accruing disproportionately to urban populations who may have easier alternatives.

Age: Working-Age Adults Drive Utilization

The analysis found that adults between ages 25 and 39 used telehealth in approximately 10% of primary care encounters — the highest rate of any age group. By contrast, children aged 0 to 2 used telehealth for less than 2% of visits, and the oldest patient cohorts showed similarly low rates.

This age gradient reflects several converging factors. Working-age adults face the greatest time constraints, making the convenience of a video visit from home or office particularly valuable. They also tend to have higher digital fluency, more reliable internet access, and fewer of the complex multi-system health concerns that necessitate physical examination. For this demographic, telehealth is a functional substitute for low-acuity primary care needs: minor illness evaluation, prescription refills, follow-up visits for stable chronic conditions.

The low telehealth rates for young children are less surprising. Pediatric primary care is inherently hands-on, with growth measurements, ear examinations, and developmental assessments that require physical presence. Parents of infants and toddlers are also likely more comfortable with in-person reassurance from their child’s provider.

Language: A Surprising Pattern of Higher Engagement

Perhaps the most counterintuitive finding in the Epic Research analysis involves patients whose preferred language is not English. Earlier research, including a study published in Health Affairs, had identified language barriers as a significant impediment to telehealth adoption — the assumption being that navigating a technology-mediated visit in a second language, often without in-person interpreter services, would reduce engagement.

The new data challenges this assumption. Patients who primarily speak Chinese, Portuguese, Russian, Persian, or Spanish showed substantially higher baseline telehealth utilization than English speakers, and maintained that advantage throughout the study period. While the analysis did not examine causation directly, Caleb Cox, head of research at Epic, has noted that factors such as the availability of professional translation services, reduced travel time, and greater convenience may play a role for these communities.

This finding has important implications for health equity. It suggests that for some non-English-speaking populations, telehealth may be removing rather than creating barriers — potentially by connecting them more easily to providers or interpreter services that would otherwise require significant logistical effort to access in person.

The Policy Landscape: Stability With Uncertainty

The stabilization of telehealth utilization is occurring against a backdrop of evolving — and recently extended — federal policy. The post-pandemic unwinding of telehealth flexibilities has been a protracted legislative process, with Congress repeatedly extending emergency provisions rather than allowing them to expire.

In early February 2026, President Donald Trump signed a federal government funding bill that extends Medicare telehealth coverage flexibilities through 2027. This represents a meaningful extension of policy stability for telehealth providers, patients, and health systems that have invested in virtual care infrastructure. The extension covers provisions that expanded geographic eligibility, permitted audio-only visits for patients lacking video capabilities, and maintained certain prescribing flexibilities.

The controlled substance prescribing question remains among the most complex ongoing policy debates in telehealth. The Drug Enforcement Administration has repeatedly extended pandemic-era waivers allowing the remote prescription of controlled substances, including stimulants for ADHD and certain opioid-based medications, without a prior in-person evaluation. The clinical, ethical, and regulatory dimensions of this issue remain contested, and permanent resolution is still forthcoming.

Mental health telehealth operates in a distinct category entirely. According to Epic’s data tracker, mental health visits conducted via telehealth accounted for more than 26% of all mental health encounters in October 2025 — a far higher share than any other specialty. This reflects both the nature of mental health care, which relies less on physical examination, and the profound unmet need for mental health services that telehealth has helped partially address.

Strategic Implications for Health Systems and Payers

The stabilization of telehealth at 6% to 7% of primary care encounters is neither a failure nor a ceiling. For health system leaders, it represents a clarification of telehealth’s role: not a wholesale replacement for in-person care, but a durable complement that serves specific patient populations and use cases particularly well.

Strategically, this equilibrium argues for investment in optimizing telehealth for the patient segments most likely to use and benefit from it — working-age adults managing chronic conditions, non-English-speaking patients with access to remote interpretation, and urban populations seeking convenient low-acuity care. It also argues for continued attention to the rural and elderly populations whose telehealth adoption lags, not by abandoning the channel but by addressing the structural barriers that impede it.

For payers, the stabilization data provides a more reliable basis for actuarial modeling and network design. Telehealth is no longer a volatile variable; it is a predictable component of the care mix. This makes it possible to design benefits structures, reimbursement rates, and network configurations around a relatively stable expected demand.

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The Epic Research findings confirm what many in healthcare suspected but could not previously quantify: telehealth has found its place in primary care, and that place is smaller than pandemic-era enthusiasm suggested but more durable than critics feared. The stabilization at 6% to 7% reflects a genuine market equilibrium, shaped by clinical realities, patient preferences, demographic factors, and regulatory conditions.

The years ahead will test whether this equilibrium holds or shifts. Continued policy stability, investments in rural broadband, and improvements in telehealth platforms — particularly around accessibility for older adults — could push utilization modestly higher. Conversely, changes in reimbursement policy or growing clinical concern about the limitations of virtual care could compress it. What seems unlikely is a return to the pandemic-era volatility that made telehealth so difficult to plan around. The technology has matured. The question now is not whether telehealth belongs in primary care, but how to deploy it most effectively for the patients and communities that need it most.

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