Demographic differences in annual wellness visit completion after expanded medicare telehealth coverage.

backgroundTelehealth may enhance preventive care access by addressing geographic and cost barriers. However, the move toward telehealth raises new questions about differences in healthcare utilization in the context of the digital divide. The objective of this study was to assess the association between race and ethnicity and the likelihood of receiving an annual wellness visit (AWV) and the utilization of telehealth to access AWVs.

methodsThis study completed a cross-sectional analysis of Medicare Fee-for-Service (FFS) beneficiaries and associated claims data. Multilevel logistic regression was used to compare beneficiary characteristics associated with receipt of AWV and with accessing AWVs in a telehealth setting. The study cohort included a 5% random sample of Medicare FFS beneficiaries aged 65 and older, enrolled in Medicare due to age, with continuous Parts A and B coverage, and with no Medicare Advantage coverage in 2021. The primary exposure was beneficiary race and ethnicity. Outcomes were receipt of an AWV in any setting and receipt of an AWV in a telehealth setting among beneficiaries who received an AWV.

resultsAmong 1,993,435 beneficiaries, 42.5% were male, 57.5% were female, 54.4% were age 65–74, 33.3% were 75–84, and 12.4% were over 85; 85.0% were White, 6.2% were Black, 4.7% were Hispanic, 2.7% were Asian/Pacific Islander, and 0.5% were American Indian/Alaska Native. Controlling for individual and county-level covariates, lower odds of receiving an AWV were observed among American Indian/Alaska Native (OR = 0.38 95% CI: 0.35–0.42), Black (OR = 0.82, 95% CI: 0.80–0.83), and Hispanic (OR = 0.78, 95% CI: 0.76–0.79) beneficiaries compared to White beneficiaries. Among AWV recipients, Black beneficiaries were more likely to use telehealth to access AWVs relative to White beneficiaries (OR = 1.14, 95% CI: 1.06–1.23).

conclusionsDespite expansion of telehealth eligibility for AWVs, racial and ethnic differences in utilization persist among Medicare FFS beneficiaries, and telehealth is rarely used to deliver the AWV benefit. However, Black beneficiaries may be more likely to use telehealth for AWVs compared to White beneficiaries. Targeted telehealth interventions could help improve access to preventive care among Medicare beneficiaries. CLINICAL TRIAL NUMBER: Not applicable.