New findings on telehealth usage in Massachusetts during the COVID-19 pandemic show disparities in use based on age and type of insurance, and researchers hope to further probe dynamics around access as they move to the next phase of the health plans-sponsored study.

One of the largest takeaways of the project is "the idea of ensuring that older adults or seniors are able to access care when it's concordant with their wishes," said Dr. Alon Peltz, the study's principal investigator.

Peltz and other researchers from the department of population medicine in the Harvard Pilgrim Health Care Institute at Harvard Medical School conducted the study, which is sponsored by the Massachusetts Association of Health Plans.

The first phase of the study, which will be followed up by interviews with patients and health care providers, involved analysis of enrollment and telehealth use data from seven MAHP member plans — Allways Health Partners, BMC HealthNet/Well Sense Health Plan, Commonwealth Care Alliance, Fallon Health, Health New England, and Point32Health (Tufts Health Plan and Harvard Pilgrim Health Care) — covering the period from January 2019 through January 2021.

Preliminary results, slated to be discussed Thursday during MAHP's virtual annual conference, show that adults age 65 and older received about 52 percent fewer telehealth visits during the pandemic than other age groups.

"When we look at the results of the age-based trends, for me as a clinician the first question that comes to mind is, we see a difference of 50 percent and that's striking," Peltz said. "I think the next question is to figure out what percent of that has to do with patient and provider preference and how much has to do with modifiable barriers, like really working with organizations that will work with older adults to try to fix some of those challenges that we see around access and digital literacy, and making sure that our practices are not ageist in any way."

Woman in exam room

Melissa ZanVettor, RN, explains how a patient might use the telemedicine room at the VA medical facility in the Conte Building on Center Street in Pittsfield. 

The analysis also tracked lower rates of telehealth use for patients with government-funded insurance than those who are commercially insured — telehealth use was 15 percent lower for Medicaid and 52 percent lower for Medicare, compared to commercial insurance. Behavioral health data for the Medicaid population are still being analyzed.

Inconclusive findings around telehealth use in predominantly Black communities indicate a need for a "deeper dive and more investigation," Peltz said.

Preliminary results showed less telehealth use for primary care in communities with higher percentages of Black residents for both Medicare and Medicaid members. With commercial insurance, communities with higher percentages of Black residents had more telehealth use for all types of visits.

MAHP President and CEO Lora Pellegrini said a final report, with recommendations, will be issued next year. She said the association wanted to conduct the study because telehealth provided people with vital access to care at the height of the pandemic, and because the technology appears to be here to stay.

Lawmakers and Gov. Charlie Baker cemented telehealth's place in the Massachusetts health care ecosystem with a January 2021 law that required insurers to permanently reimburse for behavioral telehealth at the same rate as in-person treatment, and mandated rate parity for two years for primary and chronic disease care.