# Provider‐level variation in the delivery of primary care telehealth for the rural Medicare Advantage population

## TL;DR

This study examines how primary care telehealth delivery varies for rural Medicare Advantage beneficiaries based on their providers' telehealth usage.

## Contribution

The study identifies provider-level factors influencing telehealth access for rural Medicare Advantage populations.

## Key findings

- PCPs with the highest telehealth delivery rates were more likely to provide telehealth to rural beneficiaries.
- Rural beneficiaries used less telehealth overall compared to nonrural beneficiaries.
- High-telehealth providers may have better tools for implementing telehealth services.

## Abstract

The role of telehealth use in primary care among rural Medicare Advantage (MA) beneficiaries following Medicare's expanded telehealth coverage during COVID‐19 is not well understood. With increasing evidence that provider characteristics influence patient access to telehealth, this study compared receipt of telehealth primary care between rural and nonrural MA beneficiaries by providers’ level of telehealth delivery.

Using claims for MA beneficiaries from January 2021 to June 2024, we compared the proportion of primary care visits that were delivered via telehealth between rural and nonrural beneficiaries. We then categorized primary care physician (PCP) groups into quartiles based on the provision of telehealth as a share of total primary care visits. We conducted visit‐level generalized linear regression analyses to assess whether differences in telehealth primary care receipt between rural and nonrural beneficiaries varied by PCP telehealth quartile.

PCPs delivering the highest rates of telehealth were significantly more likely to provide primary care via telehealth to rural MA beneficiaries than nonrural ones (4th quartile odds ratio: 1.12, 95% confidence interval: 1.02, 1.22). This finding differed from the overall disparity in telehealth use between rural and nonrural populations, in which rural beneficiaries used less telehealth.

Results showing increased telehealth use among rural MA beneficiaries receiving care from PCPs delivering the highest rates of telehealth may partly stem from unique capabilities among these providers, who are potentially better equipped with tools for implementing telehealth. As such, we provide insight on provider‐oriented factors that can bolster telehealth access for rural MA populations.