# The Impact of Telehealth on Healthcare Utilization, Health Behavior and Quality of Care for Middle-aged and Older Adults with Cardiometabolic Risk

> **NIH NIH F31** · UNIV OF NORTH CAROLINA CHAPEL HILL · 2024 · $24,993

## Abstract

PROJECT SUMMARY
Background: Telehealth (or telemedicine), defined as the use of technology to deliver health care, health
information, or health education remotely, has become essential to the modern healthcare system. The COVID-
19 pandemic has accelerated the need for the expansion of telehealth services. In response to the pandemic,
federal and state governments implemented temporary modifications and policies to support telehealth adoption.
However, it is unclear how telehealth policy expansions impact overall health service utilization in the United
States health system. In light of the telehealth expansions policy, it is important to evaluate the impact of
telehealth on the quality of care, especially in behavioral health care and chronic disease management for
patients with cardiometabolic risk (CMR), as telehealth may offer a potential life-course intervention for promoting
healthy aging in this area.
Specific Aims: The proposed project will (1) evaluate the impact of state-level telehealth payment parity
requiring equal reimbursement for in-person and telehealth visits on health service utilization for adults aged 45
to 64 with CMR in commercial insurance (2) assess how telehealth affects health behavior (medication
adherence) for middle-aged and older adults aged 45 or above with CMR. (3) assess how telehealth impact on
disease-specific quality of care for middle-aged and older adults aged 45 or above with CMR.
Approach: The proposed analysis will utilize data from the primary sources: (1) IBM MarketScan Commercial
Claims; (2) Medicare fee-for-service Claims. Additional data sources for covariates and instrument variables will
come from (1) the CDC COVID-19 tracker; (2) Internet broadband data from FCC and Microsoft. For Aim 1, I will
leverage a policy shock of private insurance telehealth payment mandate to identify the causal effects of interest
using a difference-in-differences (DiD) estimation framework. For Aim 2 and Aim 3, to overcome potential
endogeneity resulting from self-selection and reverse causality in telehealth use and outcomes of interest, I will
use a two-stage least squares (2SLS) approach with internet connectivity at the county level as an instrumental
variable (IV). I will use the causal inference framework to evaluate the impact of telehealth on medication
adherence and disease-specific quality of care for middle-aged and older adults with CMR.
Contribution and Significance: This study is significant because limited rigorous evidence indicates how
telehealth affects healthcare utilization and quality of care for patients with CMR based on large population
studies over an extended period beyond the pandemic. This study will contribute to understanding the impact of
telehealth reimbursement policy reform on health service utilization in the U.S. health system. In addition, this
study will provide evidence of the causal effects of telehealth on chronic disease management and quality of
care for middle-aged and older ...

## Key facts

- **NIH application ID:** 10826145
- **Project number:** 1F31HL172678-01
- **Recipient organization:** UNIV OF NORTH CAROLINA CHAPEL HILL
- **Principal Investigator:** Zhang Zhang
- **Activity code:** F31 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $24,993
- **Award type:** 1
- **Project period:** 2023-12-11 → 2024-08-06

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10826145

## Citation

> US National Institutes of Health, RePORTER application 10826145, The Impact of Telehealth on Healthcare Utilization, Health Behavior and Quality of Care for Middle-aged and Older Adults with Cardiometabolic Risk (1F31HL172678-01). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10826145. Licensed CC0.

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