INDIVIDUAL AND COMMUNITY-LEVEL FACTORS ASSOCIATED WITH TELEHEALTH UTILIZATION AMONG VULNERABLE MEDICARE BENEFICIARIES DURING THE COVID-19 PANDEMIC
Johns Hopkins University
Background: The COVID-19 Pandemic increased the use of telehealth as an avenue for vulnerable populations to receive services while social distancing. Together with telehealth policy changes, the use of telehealth soared across the United States (U.S.) health system. However, access to these digitally supported services may not have been equitable across the U.S. Objective: Using claims data, the study documents the use of Medicare Part B telehealth-eligible services within the fee-for-service Medicare program during the first year of the Pandemic. It also identifies key individual and community level characteristics associated with how vulnerable and special needs persons utilized telehealth. Methods: This is a cohort study of continuously enrolled Medicare FFS beneficiaries in 2019 and 2020. The main outcome is the utilization of telehealth-eligible services. This study used descriptive analyses and a multivariable logistic regression. Results There were 6,233,884 total beneficiaries who used telehealth eligible services with 57% females. Mean [sd] age is 71.1 [11.27] years. Between 2019 and 2020, total visits decreased by 9%. But this reduction would be lower still, if it wasn’t that telehealth contacts served as alternatives for a significant number of in-person visits in 2020. Telehealth ambulatory utilization accounted for about 1% of contacts in 2019 but 10% in 2020. Individual level factors associated with higher telehealth utilization in 2020 include younger age, female, American Indian/Alaska Native status, not having both Medicare and Medicaid coverage, having a higher number of chronic conditions, and not having the End-Stage Renal Disease. Community level socioeconomic determinants associated with higher telehealth utilization include residing in New England, urban areas, areas with lower levels of internet connectedness, higher community vulnerability. These analyses also stratified across the disabled (under 65) and the aged (over 65) subgroups. The impact of some individual and community-level factors varied across the two subgroups. Conclusion: Individual and community level factors are associated with different levels of utilization of telehealth services. Disability status effect modifies the relationship between the various individual and community level characteristics and telehealth utilization. Therefore, all stakeholders should understand these differences to affect equitable telehealth policies and strategies across the diverse Medicare population.
Telehealth, Medicare, Covid-19 Vulnerability Index (CCVI), Broadband Access, COVID-19, Social Determinants of Health (SDOH), Access, InPerson vs Telehealth, Health Disparities