While telehealth is expanding access to substance use disorder treatment in rural areas, a new study suggests that it’s failing to adequately serve Medicaid beneficiaries, as they are less likely than the privately insured to access substance use disorder treatment.
For journalists covering rural health disparities, the Medicaid cliff and the promises (and pitfalls) of telehealth, these findings demand a closer look at who’s really benefiting from the telehealth boom, and why.
Telehealth services for substance use disorder treatment have skyrocketed, from an average of 45 services a month in 2019 to nearly 11,000 by 2023, the study found.
The study, which analyzed nationwide claims data from 2019 to mid-2023, focuses on the utilization of substance use disorder treatment services, comparing in-person and telehealth modalities across different payer types (Medicaid, Medicare Advantage and commercial insurance) and between rural and urban areas. The findings are particularly relevant as state and federal policies increasingly emphasize telehealth as a means to improve access to substance use disorder treatment, especially in underserved areas.
The study revealed two very different trends. On one hand, rural communities are seeing some serious gains: Overall utilization of substance abuse treatment among the rural population jumped nearly 90% during the study period, almost double the increase seen in urban areas. That suggests telehealth is helping bridge geographic gaps in access to care.
Questions worth exploring
The study also uncovered a troubling disparity impacting Medicaid beneficiaries. Despite the overall increase in telehealth-based treatment, people covered by Medicaid actually experienced a 17% decrease in overall utilization of services. This means that telehealth increased, but it didn’t make up for the drop in in-person visits, potentially leaving a vulnerable population with less access to treatment.
As the study authors themselves point out, this raises serious equity concerns. Are there digital literacy barriers? Lack of access to reliable internet? Are providers less likely to offer telehealth to Medicaid patients?
Consider exploring how socioeconomic factors impact access, look at whether trends differ for different types of substance use disorders and, crucially, investigate the quality of care delivered via telehealth. Are outcomes as good as in-person treatment? What about patient satisfaction and adherence?
Telehealth use in the U.S. has seen a notable decline six months into 2024, compared to its peak during the COVID-19 pandemic. Telehealth volumes were 54.7% lower in the third quarter of 2023 than in the second quarter of 2020. The decline is due to a preference for in-person care and the limited effectiveness of telehealth for certain medical specialties.
Racial and ethnic disparities persist in telehealth
Virtual care advocates have long pitched video- and audio-based medical appointments as a way to reach populations historically underserved in health care, including racial and ethnic groups who face extra hurdles accessing in-person care. But a recent study in the Journal of General Internal Medicine examining patients at a federally qualified health center in Texas found that Black patients were 35% less likely than white patients to use virtual care, and Hispanic patients were 51% less likely. The gaps could be attributed to the digital divide: certain groups are less likely to have the technology or know how to use it.
As this latest study finds, enrollees in Medicare Advantage and those with commercial insurance were disproportionately more likely to use telehealth, further highlighting the gap between access and need. As policymakers continue to shape telehealth regulations, this research underscores the need for a far more nuanced approach. Telehealth isn’t a magic bullet, and its impact varies wildly depending on who you are and where you live.
