Disparities in the Use of In-Person and Telehealth Primary Care Among High- and Low-Risk Medicare Beneficiaries During COVID-19

Ying Jessica Cao
Dandi Chen
Yao Liu
Maureen Smith
Peer-Reviewed Article
December 2021


Advancing more equitable access to telehealth may require care coordination strategies deployed alongside telehealth.


At the outset of the COVID-19 pandemic in 2020, primary care visits declined sharply, and the proportion of virtual visits increased. Many groups of individuals experienced barriers in accessing telehealth care, including older adults, people of color, low-income individuals, and people with disabilities. This study examined how primary care utilization changed among a group of high- and low-risk Medicare accountable care organization (ACO) beneficiaries during the first six months of the pandemic, as well as whether there were disparities in accessing in-person or virtual primary care based on patient characteristics.


Overall, the increase in telehealth visits during this six-month period did not compensate for decreased in-person care among all beneficiaries, and use of telehealth was relatively low. The high-risk group experienced a smaller decrease in overall utilization than the low-risk group, and care management programs may have played an important role in supporting high-risk patients. Adults 86 or older, dually eligible individuals, and those living in rural/suburban areas were less likely to access telehealth, and overall there were significant disparities in both in-person and virtual primary care utilization based on race, age, gender, and insurance status. 


While telehealth could be especially beneficial for patient groups that experience barriers in access to care for reasons such as transportation and mobility barriers, many of these groups were also less likely to access telehealth during the pandemic. Care coordination interventions may help to advance more equitable access to telehealth among individuals with complex needs.

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