Evaluating Telehealth Uptake Among North Carolina Medicaid Beneficiaries With Musculoskeletal Conditions: Insights From the COVID-19 Pandemic

Authors

Salama S. Freed, Department of Health Policy and Management, Milken Institute School of Public Health, The George Washington University, Washington, DC.
Kelley A. Jones, Department of Population Health Sciences, Duke University School of Medicine.
Rebecca G. Whitaker, Duke Margolis Center for Health Policy, Duke University.
Katherine Norman, Department of Population Health Sciences, Duke University School of Medicine.
Marissa Carvalho, Department of Physical Therapy and Occupational Therapy, Duke Health, Durham NC.
Abhigya Giri, Department of Biostatistics and Bioinformatics, Milken Institute School of Public Health, The George Washington University, Washington, DC.
Ashley Lake, Duke Physical Therapy Sports Medicine at Center for Living, Duke University, Durham.
Yolande Pokam Tchuisseu, Duke Margolis Center for Health Policy, Duke University.
Samantha Repka, Duke Margolis Center for Health Policy, Duke University.
Karina Vasudeva, Department of Health Policy and Management, The University of North Carolina at Chapel Hill, Chapel Hill, NC.
Nadia Bey, Duke Margolis Center for Health Policy, Duke University.
Janet Prvu Bettger, Department of Health and Rehabilitation Sciences, Temple University, Philadelphia, PA.

Document Type

Journal Article

Publication Date

9-19-2023

Journal

Medical care

DOI

10.1097/MLR.0000000000001915

Abstract

BACKGROUND: The shift from in-person to virtual visits, known as telehealth (TH), during the COVID-19 pandemic was a significant change for North Carolina (NC) Medicaid beneficiaries seeking treatment for musculoskeletal (MSK) conditions, as remote care for these conditions was previously unavailable. We used this policy change to investigate factors associated with TH uptake and whether TH availability mitigated disparities in access to care or affected emergency department (ED) visits among these beneficiaries. RESEARCH DESIGN: Using 2019-2021 NC Medicaid claims, we identified beneficiaries receiving treatment for MSK conditions before COVID-19 (March 2019-February 2020) and analyzed uptake of newly available TH during COVID-19 (April 2020-March 2021). We used descriptive analysis and Poisson generalized estimating equations to quantify TH uptake, factors associated with TH uptake, and the association with ED visits during COVID-19. RESULTS: Black and Hispanic beneficiaries were less likely to use TH compared with White and non-Hispanic counterparts (10%, P<0.001 and 20%, P=0.03, respectively). Adults eligible for Tailored Plans, specialized NC Medicaid plans for those with significant behavioral health needs or intellectual/developmental disabilities, were less likely to use TH [adjusted risk ratio (ARR):0.83, 95% CI (0.78, 0.87)]; youth eligible for Tailored Plans were more likely to use TH [ARR:1.28, 95% CI (1.16, 1.42)]. Lower county-level internet access was associated with lower TH use [ARR: 0.85, 95% CI (0.82, 0.99)]. No statistical difference in ED utilization was observed between TH users and non-users. CONCLUSIONS: TH has the potential to deliver convenient care to beneficiaries with MSK conditions who can access it. Further research and policy changes should explore and address underlying factors driving disparities and improve equitable access to care for this population.

APA Citation

Freed, Salama S.; Jones, Kelley A.; Whitaker, Rebecca G.; Norman, Katherine; Carvalho, Marissa; Giri, Abhigya; Lake, Ashley; Tchuisseu, Yolande Pokam; Repka, Samantha; Vasudeva, Karina; Bey, Nadia; and Bettger, Janet Prvu, "Evaluating Telehealth Uptake Among North Carolina Medicaid Beneficiaries With Musculoskeletal Conditions: Insights From the COVID-19 Pandemic" (2023). GW Authored Works. Paper 3377.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/3377

Department

Health Policy and Management