found sufficient evidence to support the effectiveness of telehealth for psychotherapy (Totten et al., 2016). And a review of telemental health services found that providers, including advanced practice registered nurses, could effectively provide telemental health services that were as good as in-person services—and might even be preferred by some patients (Adams et al., 2018). It might be that health care quality is a particularly good example of how telehealth can be more successful for some services and much less so for others, even within the same medical specialty. As more patients experience telehealth services with their regular providers during the pandemic, researchers might get a much better understanding of what factors tend to support—or fail to support—highquality telehealth services. Reduce Costs If one goal of telehealth is to keep costs in check—or even decrease health care costs overall, by substituting office visits for potentially less expensive telehealth visits—making some COVID-19–related policy changes permanent could work against that goal. That is because more access leads to more utilization, and by extension, more spending. 6 In his 2014 testimony before the U.S. House of Representatives’ Energy and Commerce Committee, Subcommittee on Health, Ateev Mehrotra warned that although telehealth has great potential to reduce the cost of a particular visit or episode of care, the savings could easily be trumped by overuse of services (overutilization) (Mehrotra, 2014). In other words, if telehealth convenience inadvertently causes people to seek care that they do not need or otherwise would not have sought, telehealth could end up exacerbating the already high cost of health care in the United States. A 2017 study observed this in action: It appears that offering DTC telehealth services to reduce physician office and emergency room visits might have tapped into unmet demand for more-convenient services (Ashwood et al., 2017). Researchers examined claims data on more than 300,000 patients over three years (2011–2013) of health care use and spending on ARIs, such as bronchitis, and found that nearly 90 percent of the telehealth visits represented new utilization rather than having replaced in-person care. Spending on visits for ARIs overall increased by $45 per telehealth user, indicating that DTC telehealth use did not lower overall spending. The Congressional Budget Office (CBO), charged with evaluating the overall cost implications of legislative proposals, has offered several analyses of proposed telehealth legislation. In a pre-pandemic evaluation from 2019, CBO estimated that the proposed expansion of telehealth for the Medicare population (U.S. Congress, 2019)—which would waive both the originating-site (where the patient is located during the telehealth visit) and geographic restrictions for telemental health services—would add an additional 150,000 visits in 2021 and increase direct spending by $1 billion from 2019 through 2029 (CBO, 2019). This estimate is consistent with previous CBO estimates that assume that increasing access to telehealth would increase utilization—and therefore costs—thus providing a basis for some policy makers to balk at expanding reimbursement for telehealth. In theory, the COVID-19 pandemic could provide some evidence of the potential impact of dramatically increasing access to telehealth on health care costs. However, too much about health care delivery has changed during this time to assess the extent to which telehealth would drive new utilization in routine times. During the early months of the pandemic, it appeared that telehealth If telehealth convenience inadvertently causes people to seek care that they do not need or otherwise would not have sought, telehealth could end up exacerbating the already high cost of health care in the United States. 7 visits substituted for in-person visits and that greater use of telehealth did not lead to escalating costs (National Committee for Quality Assurance, 2020). However, these patterns occurred in the context of widespread fear of seeking in-person care and rampant deferred care. It will be key to track telehealth utilization as patients become increasingly comfortable seeking in-person care and telehealth becomes one of several attractive options for patients to engage with clinicians. Improve Access to Care If one goal of telehealth is to increase access to care and interactions with clinicians, telehealth could be particularly effective, especially if it can reach patients who have slipped through the cracks of the traditional health care delivery system. Telehealth can increase convenience for those with access to in-person care and bring needed services into communities that lack in-person providers. Some populations of patients with the most to gain from telehealth include underserved patients, those who struggle with substance use disorder (SUD), and patients with chronic conditions that require close monitoring. Underserved Populations Low-income patients often face the greatest access challenges. They are more likely to live in health care professional shortage areas, face long wait times for care, and confront various obstacles to seeking in-person care (e.g., travel costs, limited sick leave, caregiving responsibilities). Telehealth can overcome some of the longstanding access barriers that these populations have faced. During the COVID-