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

Document Type


Publication Date



access, telehealth, behavioral health, rural, Maine, MRHRC

Publication Title

The Journal of Rural Health


PURPOSE: This study assesses trends in telehealth use in Maine-a rural state with comprehensive telehealth policies-across payers, services, and rurality, and identifies barriers and facilitators to the adoption and use of telehealth services.

METHODS: Using a mixed-methods approach, researchers analyzed data from Maine's All Payer Claims Database (2008-2016) and key informant interviews with health care organization leaders to examine telehealth use and explore factors impacting telehealth adoption and implementation.

FINDINGS: Despite a 14-fold increase in the use of telehealth over the 9-year study period, use remains low-0.28% of individuals used telehealth services in 2016 compared with 0.02% in 2008. Services provided via telehealth varied by rurality; speech language pathology (SLP) was the most common type of service among rural residents, while psychiatric services were most common among urban residents. Medicaid was the primary payer for over 70% of telehealth claims in both rural and urban areas of the state, driving the increase of telehealth claims over time. Issues challenging organizations seeking to deploy telehealth included provider resistance, staff turnover, provider shortages, and lack of broadband. Key informants identified inadequate and inconsistent reimbursement as barriers to comprehensive, systematic billing for telehealth services, resulting in underrepresentation of telehealth services in claims data.

CONCLUSIONS: Claims covered by Medicaid account for much of the observed expansion of telehealth use in Maine. Telehealth appears to be improving access to behavioral health and SLP services. Provider shortages, broadband, and Medicare and commercial coverage policies limit the use of telehealth services in rural areas.

[Journal Abstract]


FMI: contact Yvonne Jonk (

Acknowledgments: The authors would like to acknowledge Oghenetega Dibie, MS, for his help with constructing the administrative claims database and identifying telehealth claims. The All‐Payer Claims Data were made available under a Memorandum of Understanding between the Maine Health Data Organization and the University of Southern Maine to support research and workforce training in health data analytics. This research was a product of the Rural Telehealth Research Center, and it was supported by a Cooperative Agreement with the Federal Office of Rural Health Policy (FORHP), Health Resources and Services Administration (HRSA), Department of Health and Human Services (HHS) (Grant no. UICRH29074). The information, content, and conclusions in the manuscript are those of the authors, and no endorsement by FORHP, HRSA, or HHS is intended or should be inferred.

© 2020 National Rural Health Association

Funding Organization

Federal Office of Rural Health Policy

Grant Number