Before March 2020, telehealth accounted for less than 1% of all medical visits in the United States. By April 2020, it was 38% — a 38-fold increase in a matter of weeks. The question was never whether the surge would happen. The question was whether it would last.

Five years later, the answer is in: telehealth didn't just survive the pandemic. It earned a permanent address in the American healthcare system. But the form it has taken differs significantly from what the early boosters imagined.

The Regulatory Dam Breaks

The single most important enabler of telehealth's growth was regulatory. For decades, federal and state regulations restricted virtual care: Medicare wouldn't pay for it, cross-state licensing was forbidden, and prescribing via video was heavily limited. These weren't technological barriers — they were policy choices.

When COVID-19 arrived, those barriers evaporated almost overnight. The Centers for Medicare & Medicaid Services (CMS) issued emergency waivers allowing reimbursement for telehealth at parity with in-person visits. States suspended licensing requirements for cross-state practice. The Drug Enforcement Administration relaxed rules on prescribing controlled substances via telehealth.

The pandemic proved that the barriers to telehealth were never technical. They were regulatory. And once the regulations changed, adoption followed within weeks.

The critical question post-pandemic was whether these emergency waivers would become permanent. The answer has been mixed but largely positive. As of 2025, CMS has made telehealth reimbursement flexibilities permanent for behavioral health services and extended others through legislative action. State-level licensing compacts have expanded. The regulatory architecture built during the emergency is hardening into permanent infrastructure.

What Telehealth Actually Looks Like Now

The reality of telehealth in 2025 is more nuanced than the "doctor over video" vision. Virtual care has stratified into several distinct categories:

  • Behavioral health remains the dominant telehealth use case. Mental health and therapy visits are still conducted virtually at rates exceeding 50% — a shift that dovetails with our analysis of digital mental health tools. The intimacy of therapy turns out to translate well to video.
  • Chronic disease management has embraced virtual care for routine check-ins. Diabetes, hypertension, and medication management visits are frequently conducted remotely, supplemented by home monitoring devices.
  • Urgent care and triage services have made virtual visits a first touchpoint, routing patients to in-person care when necessary.
  • Specialty consults — particularly in areas with specialist shortages — use telehealth to connect patients in rural areas with urban specialists.

The Plateau

After the 2020 peak, telehealth usage declined as in-person care resumed. But it plateaued at a level dramatically higher than pre-pandemic. As of 2024, telehealth accounts for approximately 12-15% of all outpatient visits — down from the 38% peak, but roughly 15 times the pre-pandemic baseline.

This plateau reflects a natural equilibrium. Not every visit needs to be virtual, and not every visit needs to be in person. The healthcare system has found its balance point, and it's dramatically more virtual than before.

The Infrastructure Layer

The most lasting telehealth transformation may be invisible to patients. Behind the video visits, a new infrastructure layer has been built: remote patient monitoring devices, asynchronous messaging platforms, AI-assisted triage, and integrated electronic health records that connect virtual and in-person care.

This infrastructure is what makes telehealth durable. The video call is the visible surface; the data integration, reimbursement coding, and clinical workflow redesign are what make it a sustainable part of the system.

The Digital Divide Persists

Not everyone benefited equally. Telehealth adoption has been significantly lower among elderly patients, low-income populations, and rural communities — paradoxically, the groups that could benefit most. Broadband access remains a barrier, a challenge we examine in our analysis of broadband as essential infrastructure.

Language barriers, digital literacy, and the design of telehealth platforms themselves have all contributed to unequal access. The healthcare system accelerated, but it didn't accelerate for everyone.

What Comes Next

The next phase of telehealth evolution is likely to be less about video visits and more about continuous care. Wearable devices, ambient sensors, and AI-driven health monitoring promise to extend virtual care beyond scheduled appointments into always-on health tracking.

The mRNA platform technology that accelerated during the pandemic represents a parallel track — not telehealth per se, but part of the same digitization and acceleration of healthcare delivery. Together, these shifts suggest that the pandemic didn't just add a virtual channel to healthcare. It began a fundamental reengineering of how care is delivered.

Telehealth has its permanent residency. The work now is making sure it serves everyone — not just those with the broadband, devices, and digital literacy to use it.