ABSTRACT More than 47 million Americans live in rural areas, where individuals face geographic barriers to health, high costs of care, and provider shortages. Numerous consumer surveys have shown that a vast majority of individuals are interested in improving access to medical care through telemedicine technologies. Telemedicine technologies can be used to virtually deliver care, with the potential to increase access to primary and specialty care for individuals, particularly in rural areas. Telemedicine may also impact the cost of care through multiple mechanisms. While the costs of telemedicine services are generally lower than their in- person counterparts, it is unclear how telemedicine encounters affect spending and utilization over longer episodes of care, and how telemedicine can be used to introduce more low-cost providers into traditional provider networks. This study seeks to provide a comprehensive understanding of how telemedicine is currently being used across payer types and patient populations, particularly after the implementation of new reimbursement policies surrounding telemedicine, as well as assess the impact of telemedicine use on follow- up care. These results address important health policy questions, including 1) which telemedicine services generate the largest cost savings relative to traditional care, and 2) the impact of policies increasing the reimbursement of telemedicine services on both telemedicine-specific, and overall spending and utilization of health care services. Additionally, this study aims to examine how telemedicine providers may be incorporated into provider networks to meet access to care standards, and whether contracting with distant providers may improve insurers’ bargaining power with existing providers in rural areas. Results from this study will inform policymakers, payers and practitioners about the current landscape of telemedicine across payer and population groups, and the impact of telemedicine on access to, and cost of care.

PROJECT NARRATIVE This project seeks to examine the impact of telemedicine encounters and telemedicine policies on access to care, and spending and utilization of health care services. I will synthesize data from medical and pharmacy claims, state-level provider networks, surveys, and administrative sources to model the effect of telemedicine encounters, policies, and the inclusion of telemedicine providers in provider networks, on cost, utilization and access outcomes. This work directly addresses policies related to the coverage of telemedicine services, and provides policymakers an economic view of the impact of telemedicine care in rural areas.