Telehealth Use in a Rural State: A Mixed-Methods Study Using Maine's All-Payer Claims Database

Area of Science:

• Health Services Research
• Rural Health
• Digital Health

Background:

• Maine, a rural state, has comprehensive telehealth policies.
• Understanding telehealth adoption is crucial for improving healthcare access in rural settings.

Purpose of the Study:

• Assess telehealth use trends across payers, services, and rurality in Maine.
• Identify barriers and facilitators to telehealth adoption and use.

Main Methods:

• Mixed-methods approach using Maine's All Payer Claims Database (2008-2016).
• Key informant interviews with healthcare organization leaders.
• Analysis of telehealth utilization and influencing factors.

Main Results:

• Telehealth use increased 14-fold from 2008 to 2016, but remained low (0.28% in 2016).
• Service utilization varied by rurality: speech-language pathology (SLP) in rural areas, psychiatric services in urban.
• Medicaid was the primary payer (over 70%), driving the increase; provider resistance, shortages, and lack of broadband were key barriers.

Conclusions:

• Medicaid claims significantly contributed to telehealth expansion in Maine.
• Telehealth improves access to behavioral health and SLP services.
• Provider shortages, broadband, and reimbursement policies limit rural telehealth use.