Pandemic-Triggered Adoption of Telehealth in Underserved Communities: Descriptive Study of Pre- and Postshutdown Trends

Abstract

Background: The adoption of telehealth services has been a challenge in rural communities. The reasons for the slow adoption of such technology-driven services have been attributed to social norms, health care policies, and a lack of infrastructure to support the delivery of services. However, the COVID-19 pandemic-related shutdown of in-person health care services resulted in the usage of telehealth services as a necessity rather than a choice. The pandemic also fast-tracked some needed legislation to allow medical cost reimbursement for remote examination and health care services. As services return to normalcy, it is important to examine whether the usage of telehealth services during the period of a shutdown has changed any of the trends in the acceptance of telehealth as a reliable alternative to traditional in-person health care services.

Objective: Our aim was to explore whether the temporary shift to telehealth services has changed the attitudes toward the usage of technology-enabled health services in rural communities.

Methods: We examined the Medicaid reimbursement data for the state of Alabama from March 2019 through June 2021. Selecting the telehealth service codes, we explored the adoption rates in 3 phases of the COVID-19 shutdown: prepandemic, pandemic before the rollout of mass vaccination, and pandemic after the rollout of mass vaccination.

Results: The trend in telemedicine claims had an opposite pattern to that in nontelemedicine claims across the 3 periods. The distribution of various characteristics of patients who used telemedicine (age group, gender, race, level of rurality, and service provider type) was different across the 3 periods. Claims related to behavior and mental health had the highest rates of telemedicine usage after the onset of the pandemic. The rate of telemedicine usage remained at a high level after the rollout of mass vaccination.

Conclusions: The current trends indicate that adoption of telehealth services is likely to increase postpandemic and that the consumers (patients), service providers, health care establishments, insurance companies, and state and local policies have changed their attitudes toward telehealth. An increase in the use of telehealth could help local and federal governments address the shortage of health care facilities and service providers in underserved communities, and patients can get the much-needed care in a timely and effective manner.

Keywords: COVID-19; Medicaid; health care facility; health care service; health claim; health insurance; health service; mental health; rural communities; technology adoption; telehealth; telehealth services; telemedicine; undeserved community; undeserved population.

Figure 1

Illustration of study periods.

Figure 2

Overview of monthly COVID-19 cases, vaccination, and telemedicine usage in Alabama. The “Total Claims” and “Nontelemedicine Claims” series are plotted on the right-hand axis, while the other data series are plotted on the left-hand axis.

Figure 3

Telemedicine claims by provider type.

Figure 4

Rate of telemedicine visits by age group.

Figure 5

Rate of telemedicine visits by gender.

Figure 6

Rate of telemedicine visits by race.

Figure 7

Rate of telemedicine visits by rurality.

Figure 8

Rate of telemedicine visits by provider type.