Access to care through telehealth among U.S. Medicare beneficiaries in the wake of the COVID-19 pandemic

BACKGROUND: The coronavirus disease 2019 (COVID-19) public health emergency has amplified the potential value of deploying telehealth solutions. Less is known about how trends in access to care through telehealth changed over time. OBJECTIVES: To investigate trends in forgone care and telehealth coverage among Medicare beneficiaries during the COVID-19 pandemic. METHODS: A cross-sectional study design was used to analyze the outcomes of 31,907 Medicare beneficiaries using data from three waves of survey data from the Medicare Current Beneficiary Survey COVID-19 Supplement (Summer 2020, Fall 2020, and Winter 2021). We identified informative variables through a multivariate classification analysis utilizing Random Forest machine learning techniques. FINDINGS: The rate of reported forgone medical care because of COVID-19 decreased largely (22.89–3.31%) with a small increase in telehealth coverage (56.24–61.84%) from the week of June 7, 2020, to the week of April 4 to 25, 2021. Overall, there were 21.97% of respondents did not know whether their primary care providers offered telehealth services; the rates of forgone care and telehealth coverage were 11.68 and 59.52% (11.73 and 81.18% from yes and no responses). Our machine learning model predicted the outcomes accurately utilizing 43 variables. Informative factors included Medicare beneficiaries' age, Medicare-Medicaid dual eligibility, ability to access basic needs, certain mental and physical health conditions, and interview date. CONCLUSIONS: This cross-sectional survey study found proliferation and utilization of telehealth services in certain subgroups during the COVID-19 pandemic, providing important access to care. There is a need to confront traditional barriers to the proliferation of telehealth. Policymakers must continue to identify effective means of maintaining continuity of care and growth of telehealth services.