Utilization and quality among Medicare Advantage beneficiaries with high vs low access to telehealth

Access to telehealth care has increased markedly in recent years, especially for patients in the Medicare Advantage (MA) program. Given the unique features of MA, such as capitated payment and provider networks, understanding the impact of telehealth availability on quality, costs, and utilization is important for informing coverage and payment decisions. We compared quality and utilization outcomes among MA beneficiaries with varying access to telehealth, using MA encounter data from a 20% national random sample of enrollees from 2019 to 2021. We found that high-telehealth access was associated with a 13.4% decrease in in-person evaluation and management (E&M) visits, relative to the period prior to the pandemic onset. Given that this decrease was offset by increases in telehealth E&M visits, there was no change in total E&M visits. High-telehealth access was also associated with a 4.8% decrease in total emergency department (ED) visits, but no differences in preventable ED visits, total hospital admissions, or ambulatory care-sensitive admissions. Increases in telehealth-delivered E&M visits among MA beneficiaries with high-telehealth access offset decreases in in-person-delivered E&M visits. These findings may help clinicians and policymakers contextualize the relationship between broader access to telehealth for MA enrollees and various types of health care utilization.