Telehealth for Medicare Beneficiaries with Chronic Conditions: No Panacea for COVID-19 Pandemic Access Challenges

Tracy Haidar
Taylor Melanson
Rouguia Barry
Ilene Harris
Older patient having a telehealth call with physician

Despite rapid growth spurred by the COVID-19 pandemic, telehealth visits offset less than half (40%) of the decline in in-person visits for Medicare fee-for-service beneficiaries with hypertension, congestive heart failure, diabetes, asthma, or chronic obstructive pulmonary disease, according to a new study by AIR using Medicare claims data.

The five chronic conditions are a subset of ambulatory care sensitive conditions (ACSCs)—or conditions where hospitalizations can generally be avoided if patients have access to effective primary care. Care disruptions—like those during the early days of the pandemic—can be particularly harmful for people with ACSCs if they must delay or go without care.

The study also found that compared to the peak during the pandemic’s first wave, telehealth visits as a proportion of all Medicare ambulatory visits declined significantly for primary care and specialty care but remained high for behavioral health.

As policymakers consider whether to extend the expanded Medicare fee-for-service telehealth coverage, the findings suggest that ending telehealth flexibilities for primary care and specialty care are unlikely to lead to large decreases in ambulatory care use for Medicare beneficiaries with ACSCs. However, additional research is needed to assess the impact of ending telehealth flexibilities on equitable healthcare access and quality.

From the Brief: Telehealth as a Proportion of All Ambulatory Care Visits for Medicare Beneficiaries with a Select Ambulatory Care Sensitive Condition, by Visit/Specialty Type, 2017-2021

Exhibit 5


Key Findings

  • Telehealth visits for ambulatory care peaked in the second quarter of 2020 but only offset less than half of the decline in in-person visits for elderly Medicare beneficiaries with at least one of five ACSCs.
  • Telehealth visits increased across primary, specialty, and especially behavioral health care at the start of the pandemic, but telehealth visits for primary and specialty care declined significantly by the third quarter of 2020.
  • Comparing ambulatory care use during the pandemic to pre-pandemic levels, indicates disparities existed in delayed and forgone care by race and ethnicity, rural and urban residency, and Medicare-Medicaid dual eligibility status.