Access to Mental Health Providers Among Older Adults With ADRD Using Telemedicine.

OBJECTIVE

To examine whether having tele-mental health (tele-MH) visits with new providers is different by race, ethnicity, Medicare-Medicaid dual eligibility, and rurality.

DESIGN

Retrospective study.

SETTING AND

PARTICIPANTS

This study linked 2019 and 2021 Medicare claims data. We included community-dwelling Medicare fee-for-service beneficiaries with Alzheimer's disease and related dementias who had at least 1 tele-MH visit in 2021.

METHODS

The outcome variable was whether an individual had tele-MH visits with new providers in 2021, compared with providers they had in 2019, measured by comparing the list of providers they had visits with using Medicare outpatient claims data. The main variables of interest were race, ethnicity, Medicare-Medicaid dual eligibility, and rurality, measured using the Medicare Beneficiary Summary File. Logistic regression models, with zip code-level random effects, were estimated while accounting for individual- and community-level characteristics.

RESULTS

The analytical sample included 99,329 individuals, of whom 53.6% had MH care with new providers via tele-MH services in 2021. After accounting for individual- and community-level characteristics, Black individuals [odds ratio (OR), 1.158; 95% CI, 1.096-1.222; P < .01], Medicare-Medicaid dual-eligibles (OR, 1.066; 95% CI, 1.027-1.105; P < .01), and rural residents (1.215; 95% CI, 1.125-1.312; P < .01) were more likely to have tele-MH visits with new providers compared with their White, nondual-eligible, and metropolitan counterparts, respectively.

CONCLUSIONS AND IMPLICATIONS: Telemedicine may improve MH care access for underserved populations by facilitating connections with new MH providers.