Healthcare Insights

Telehealth utilization: metropolitan vs. micropolitan

Micropolitan communities (nonmetropolitan areas centered on a population core of 10,000-50,000 people) are home to most of the country’s rural residents. People living in rural areas often face serious health disparities compared to those living in areas of greater density.

For instance, rural residents are more likely to die from chronic conditions, according to the CDC, and rural children with mental or developmental disorders face more challenges than their peers in non-rural settings. While telehealth has helped to close the gap somewhat, staffing and access remain major barriers to addressing these issues. (You can learn more about the role of telehealth in mental health and chronic conditions here.)

A central goal of telehealth is to help patients who would otherwise struggle to keep an in-person appointment. This has clear benefits for patients in rural environments, who may have to travel long distances to the nearest doctor’s office or healthcare facility. However, there’s still plenty of room to improve telehealth access in these areas, even as overall use soars.

Using Definitive Healthcare’s PhysicianGroupView product, we calculated the percentage of telehealth visits and unique patient visits in metropolitan areas versus micropolitan areas for 2021 and 2022.

Percentage breakdown of telehealth visits and unique patient visits, 2021 and 2022

2021 Telehealth visits2021 Telehealth unique patients2022 Telehealth visits2022 Telehealth unique patientsExplore dataset

Fig. 1—Data is from the Definitive Healthcare platform. Data accurate as of December 2022.

How does micropolitan and metropolitan telehealth usage compare?

Micropolitan areas had 3.59% of telehealth visits in 2021 and 2.96% of telehealth visits in 2022 so far. Additionally, micropolitan areas had 3.95% of telehealth unique patients in 2021 and 3.56% of teleheath unique patients in 2022.

This year, 3.02% of all outpatient visits in micropolitan areas have been telehealth visits, as opposed to 5.53% of outpatient visits in metropolitan areas. This represents a 1.72% increase for metropolitan areas and a .26% increase for micropolitan areas, relative to 2021.

This data suggests the use of telehealth increased more among those who live in metropolitan areas. Researchers at the RAND Corporation found similar results and highlighted that the increase in telehealth use was greatest in areas with low poverty levels. According to the RAND study, Metropolitan areas had about 50 telemedicine visits per 10,000 people, compared to about 31 visits per 10,000 people in rural areas. This may explain why data from Definitive Healthcare’s PhysicianGroupView product found that telehealth visits were predominantly in metropolitan areas.

What do micropolitan and metropolitan mean?

The micropolitan and metropolitan designations are part of a framework developed by the Office of Management and Budget (OMB) based on the concept of core-based statistical areas, or CBSAs. The CBSA scheme enables OMB to classify metropolitan and micropolitan at the county level based on each county’s proximity to a densely populated urban “core.”

Micropolitan areas must have an urban cluster of at least 10,000 people but fewer than 50,000 people. Metropolitan areas must have an urban core of at least 50,000 people, plus adjacent counties having a high degree of social and economic integration with the core as measured through commuting ties.

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