JMIR Publications

ABSTRACT

Background:

Limited availability of in-person healthcare services and fear of contracting COVID-19 during the pandemic promoted an increased reliance on telemedicine. However, longstanding inequities in telemedicine due to unequal levels of digital literacy and internet connectivity among different age groups raise concerns about whether the uptake of telemedicine has exacerbated or alleviated those inequities.

Objective:

To examine changes in telemedicine and in-person health service use during the COVID-19 pandemic across age groups for Medicaid beneficiaries in the state of Louisiana.

Methods:

Interrupted time series (ITS) models were used on Louisiana Medicaid claims data to estimate trends in total, in-person, and telemedicine monthly office visit claims per 1,000 Medicaid beneficiaries between January 2018 through December 2020. Changes in care pattern trends and levels were estimated around the infection peaks (April 2020 and July 2020) and for an end-of-year infection levelling off period (December 2020). Four mutually exclusive age categories—0 to 17, 18 to 34, 35 to 49, and 50 to 64—were used to compare differences.

Results:

Prior to the COVID-19 pandemic, telemedicine services accounted for less than 1% of total office visit claim volume across age groups. Each age group followed similar patterns of sharp increases in April 2020, downward trends until sharp increases again in July 2020, followed by flat trends thereafter until December 2020. These sharp increases were most pronounced for older patients with those aged 50 to 64 seeing increases of 184.09 telemedicine claims per 1,000 Medicaid beneficiaries in April 2020 (95% CI: 172.19 to 195.99) and 120.81 in July 2020 (95% CI: 101.32 to 140.31) compared with those aged 18 to 34 seeing increases of 84.47 (95% CI: 78.64 to 90.31) and 57.00 (95% CI: 48.21 to 65.79), respectively. This resulted in overall changes from baseline to December 2020 levels of 123.65 (95% CI: 112.79 to 134.51) for those aged 50 to 64 compared with 59.07 (95% CI: 53.89 to 64.24) for those aged 18 to 34.

Conclusions:

Older Medicaid beneficiaries in Louisiana had higher rates of telemedicine claim volume during the COVID-19 pandemic compared to younger beneficiaries.