Disparities in the Use of In-Person and Telehealth Primary Care Among High- and Low-Risk Medicare Beneficiaries During COVID-19

Ying Jessica Cao; Dandi Chen; Yao Liu; Maureen Smith

doi:10.1177/23743735211065274

Disparities in the Use of In-Person and Telehealth Primary Care Among High- and Low-Risk Medicare Beneficiaries During COVID-19

J Patient Exp. 2021 Dec 13:8:23743735211065274. doi: 10.1177/23743735211065274. eCollection 2021.

Authors

Ying Jessica Cao¹, Dandi Chen¹, Yao Liu², Maureen Smith^{1

3

4}

Affiliations

¹ Department of Population Health Sciences, University of Wisconsin-Madison, Madison, WI, USA.
² Department of Ophthalmology and Visual Sciences, University of Wisconsin-Madison, Madison, WI, USA.
³ Department of Family Medicine and Community Health, University of Wisconsin-Madison, Madison, WI, USA.
⁴ Health Innovation Program, University of Wisconsin-Madison, Madison, WI, USA.

Abstract

We conducted a retrospective cohort study using a difference-in-differences design to estimate differences in primary care outpatient clinic visit utilization among high- and low-risk Medicare aging beneficiaries from an Accountable Care Organization during the COVID-19 pandemic compared to a control cohort from the previous year. High-risk was defined as having a Hierarchical Condition Category score of 2 or higher. A total of 582 101 patient-month records were analyzed. After adjusting for patient characteristics, those in the high-risk group had 339 (95% CI [333, 345]) monthly outpatient encounters (in-person and telehealth) per 1000 patients compared to 186 (95% CI [182, 190]) in the low-risk group. This represented a 22.8% and 26.5% decline from the previous year in each group, respectively. Within each group, there was lower utilization among those who were older, male, or dually eligible for Medicaid in the high-risk group and among those who were younger, male, or non-white in the low-risk group. Telehealth use was less common among patients who were older, dually eligible for Medicaid or living in rural/suburban areas compared to urban areas. All results were significant at the 95% level. We found significant disparities based on age, gender, insurance status, and non-white race in primary care utilization during the pandemic among Medicare beneficiaries. With the exception of gender, these disparities differed between high- and low-risk groups. Interventions targeting these vulnerable groups may improve health equity in the setting of public health emergencies.

Keywords: COVID-19; Telehealth; aging; medicare; outpatient.