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Telehealth Study Finds a Willing Market in ACA Enrollees

A RAND report finds that recent enrollees in California are making ample use of teledermatology. So are people who wouldn't normally use the service.

By Eric Wicklund

- A RAND Health study has found that teledermatology can boost the number of people accessing dermatology services, both online and in person.

That includes people who might not otherwise want – or need – to see a dermatologist.

The study by Lori Uscher-Pines, a policy researcher at the non-profit, targeted some 380,000 Medicaid enrollees in California’s Central Valley, including about 108,000 who’d recently enrolled under the Affordable Care Act. Faced with a shortage of dermatologists, the region’s MediCal managed plan, the Health Plan of San Joaquin, launched a teledermatology program in 2012.

According to Uscher-Pines, just having access to a dermatologist online prompted primary care physicians to use the service, doubling the number of patients who received care from a dermatologist. In addition, patients referred to a teledermatologist were more likely to visit a dermatologist, often more than once and for less-severe skin conditions like acne or warts.

In essence, just having the service available made everyone – doctors and patients – want to use it.

“While in-person dermatologists served many of the patients with the greatest medical need, teledermatology expanded access to a new group of enrollees with different demographics and different needs,” said Uscher-Pines, whose study was published in the May edition of JAMA Dermatology. “Our findings show that among at least one large population of Medicaid patients, teledermatology can improve access to medical specialists.”

The platform employed by the Health Plan of San Joaquin combined online consults with clinic visits. At first, physicians generally took digital images of skin problems and sent them, along with background data on patients, to a teledermatologist via a secure portal. The teledermatologist would then analyze the data and send back a report within days.

In time, the study found that physicians would refer their patients to one of two clinics in the region, where the patients were interviewed by a teledermatology nurse. The nurse took digital images of each patient’s skin problem and sent them to the teledermatologist, who analyzed the data and sent a report back to both the patient and primary care provider. If necessary, a follow-up visit would then be scheduled at the clinic.

Uscher-Pines’ study found that half of all patients needing dermatology care were served by the teledermatology platform, while in 2014 alone, three-quarters of those who’d enrolled under the ACA used the service.

This could mean that telehealth services will find strong support – and offer healthcare providers a business case – among ACA enrollees. It also hints to the symbiotic relationship between telehealth providers and brick-and-mortar clinics, as well as primary care providers.

In the future, the study researchers said, the platform might also serve as a substitute for in-person care, thus reducing costs and improving consumer convenience.

Uscher-Pines was joined in the study by Rosalie Malsberger, Lane Burgette and Andrew Mulcahy of RAND and Ateev Mehrotra of RAND and the Harvard Medical School. The California Health Care Foundation supported the study. 

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