Association Between Public Health Partnership and Telehealth Infrastructure and Medicare Cost and Disparities Among Patients With Depression

OBJECTIVES: The COVID-19 pandemic has underscored the importance of public health systems (PHS) partnership and telehealth. The objective of the study is to examine the association between PHS partnership and telehealth-post discharge and racial disparities in health care expenditures among patients with depression and coexisting multiple chronic conditions.

METHODS: The analysis used a merged dataset of 2020 CMS Medicare inpatient claims data, the Medicare Beneficiary Summary File, and the American Hospital Annual Survey. Our study focuses on community-dwelling Medicare fee-for-service beneficiaries aged 65 years and up who had depression and multiple chronic conditions (MCC). PHS partnership was defined as one if the hospital reported a partnership with local or state public health organizations or local or state human/social service organizations and zero as otherwise. Telehealth-post-discharge was defined as one if the hospital adopted telehealth remote patient monitoring post-discharge or telehealth remote patient monitoring for ongoing chronic care management, and zero as otherwise. The total cost of Medicare payments per person per year was the sum of Medicare payments on major services. We used the generalized linear model with log link and gamma variance distribution to estimate the total Medicare payments.

RESULTS: Compared to White, Black patients with depression and MCC encountered significantly higher total medical costs (coef=0.19, p<0.001). Results showed that compared to patients treated in hospitals with neither a PHS partnership nor telehealth-post discharge, beneficiaries treated in hospitals with a PHS partnership and telehealth-post discharge encountered significantly lower Medicare payments (coef=-0.04, p<0.001). The interaction term showed that the Black patients treated in hospitals with telehealth post-discharge and PHS faced significantly lower Medicare costs than their counterparts (coef=-0.08, p<0.05).

CONCLUSIONS: Results demonstrated the importance of combining PHS partnership + telehealth-post discharge to improve the efficiency of the healthcare delivery system and health equity, particularly for Black patients with depression and MCC.