Using Administrative Data to Examine Telemedicine Usage Among Medicaid Beneficiaries During the Coronavirus Disease 2019 Pandemic

Abstract

Background: The coronavirus disease 2019 (COVID-19) pandemic necessitated the replacement of in-person physician consultations with telemedicine. During the pandemic, Medicaid covered the cost of telemedicine visits. Objectives: The aim was to measure the adoption of telemedicine during the pandemic. We focus on key patient subgroups including those with chronic conditions, those living in urban versus rural areas, and different age groups. Methods: This study examined the universe of claims made by Florida Medicaid beneficiaries (n=2.4 million) between January 2019 and July 2020. Outpatient visits were identified as in-person or telemedicine. Telemedicine visits were classified into audio-visual or audio-only visits. Results: We find that telemedicine offsets much of the decline in in-person outpatient visits among Florida’s Medicaid enrollees, however, uptake differs by enrollee type. High utilizers of care and beneficiaries with chronic conditions were significantly more likely to use telemedicine, while enrollees living in rural areas and health professional shortage areas were moderately less likely to use telemedicine. Elderly Medicaid recipients (dual-eligibles) used audio-only telemedicine visits at higher rates than other age groups, and the demand for these consultations is more persistent. Conclusions: Telemedicine offset the decline in health care utilization among Florida’s Medicaid-enrolled population during the novel coronavirus pandemic, with particularly high uptake among those with prior histories of high utilization. Audio-only visits are a potentially important method of delivery for the oldest Medicaid beneficiaries.

Telehealth Expansion, Internet Speed, and Primary Care Access Before and During COVID-19

“…Telehealth offset over half of their in-person visit decline, highlighting the large residual post-PHE health care deficit for beneficiaries with chronic disease. Findings mirror literature documenting expanded telehealth chronic disease management post-PHE without a net visit increase providing reassurance that telehealth will not induce unnecessary utilization . In tandem, HSI expansion is unlikely to promote preventive care among healthy younger adults.…”

Telehealth for Chronic Disease Management Among Vulnerable Populations

“…Given the qualifications for Medicaid in Florida, this finding is reasonable as people in lower income positions are associated with less resources and less access to telehealth. Research suggested that chronic disease management via telehealth and in-person care provide similar clinical outcomes, yet the lack of in-person options did not encourage telehealth use [17,29,30]. The pandemic decreased the options for people in vulnerable communities to receive care and adversely affected chronic disease management [17].…”

“…Research suggested that chronic disease management via telehealth and in-person care provide similar clinical outcomes, yet the lack of in-person options did not encourage telehealth use [17,29,30]. The pandemic decreased the options for people in vulnerable communities to receive care and adversely affected chronic disease management [17]. Chudasama et al (2020) reported that 67% of providers perceived that the pandemic had a moderate to severe effect on chronic disease management; 45% of healthcare professionals offered only telephone support, 35% provided telephone and in-person, and 14% maintained only in-person care [15].…”

“…Medicaid enrollees are disproportionately affected by chronic diseases; thus the lack of telehealth use is concerning [11,12,16,17]. Among online health communities for individuals with chronic disease, telehealth use during the first few weeks of COVID-19 among Medicaid recipients (5%) was lower when compared to Medicare (47%), and private insurance recipients (43%) [16].…”

Patient Characteristics and Telemedicine Use in the US, 2022

“…Several studies from early in the COVID-19 pandemic found less use of telemedicine visits and in fewer video telemedicine visits (than audio-only visits) among patients who were low-income, non-English-speaking, and older age. 12,13,[16][17][18][19][20] To our knowledge, few studies have examined how telemedicine use, and its modalities, has evolved. 5 If telemedicine is to remain a common and important approach to health care delivery, it is necessary to understand who is using the technology successfully and why, and, conversely, uncover barriers in access.…”