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Telemedicine Could Help Medicaid Patients With Specialty Access

A new study in JAMA finds that specialty access standards aren't helping Medicaid patients with specialty referrals, and suggests telemedicine could improve that access.

Source: ThinkStock

By Eric Wicklund

- New research indicates telemedicine consults for specialty referrals could improve much-needed access for Medicaid populations.

It also could offer support to an innovative telehealth platform now being used in nine states to connect doctors, Medicaid patients and specialists online.

That conclusion comes out of a study, reported in the Aug. 14 online edition of JAMA Internal Medicine, which found that specialty access standards adopted by some state Medicaid programs did not make specialty care more accessible for beneficiaries. Researchers instead suggested “more innovative solutions,” such as a digital health platform enabling beneficiaries to meet specialists online.

“One way to make specialty care more available is to facilitate electronic or telemedicine specialty consultation,” Mitchell H. Katz, MD, of the Los Angeles Department of Health Services, wrote in an accompanying editorial. “Whether time synchronous (i.e. patient and physician are connected audibly and/or visually at separate locations) or dyssynchronous (electric consultation sent by a primary care physician to a specialist who responds in a matter of days) these alternative type of consultations allow patients to receive rapid specialty advice without the need for traveling and typically at lower cost.”

Katz also highlighted a significant barrier to telemedicine consults: reimbursement.

“For these visits to be financially sustainable, the provider must be in a capitated system or there must be billing codes for such visits,” he pointed out. “[A]t the moment electronic consultations cannot generally be billed under Medicare, fee-for-service Medicaid or private insurance. The move toward fee-for-value and away from fee-for-service encourages use of these innovative specialty services.”

The conclusion comes out of a study done by Chima D. Ndumela, PhD, Michael S. Cohen, SM, and Paul D. Cleary of the Department of Health Policy and Management at the Yale School of Public Health. Using Consumer Assessment of Healthcare Providers and Systems (HCAPS) survey data on Medicaid Managed Care (MMC) beneficiaries in five states from 2005-2011, they found that specialty access standards focused on appointment wait time and provider distance didn’t reduce access disparities between the MMA beneficiaries and patients in commercial plans.

“Specialty access standards did not lead to widespread improvements in access to specialist physicians,” they concluded in the study. “Meaningful improvements in access to specialty care for Medicaid recipients may require additional interventions.”

And this is where telemedicine comes into play.

Telemedicine advocates say the eConsult platform, developed in 2015 for the Connecticut-based Community Health Center and now in use in nine states, from Maine to the Pacific Northwest could fit that bill.

The platform connects primary care doctors treating Medicaid and other underserved populations with specialists, allowing them to collaborate online and set up patient consults when necessary.

“This thing makes people happy,” Darren Anderson, MD, CHC’s vice president and chief quality officer and director of the Weitzman Institute, a community-based research center founded to help Federally Qualified Health Centers improve primary care services for the underserved, said during a presentation at the Northeast Telehealth Resource Center’s conference this past May in Massachusetts.

Additionally, the platform has received CMS approval for Medicaid reimbursement.

“With limited specialty providers available to treat Medicaid patients, appointment wait times can be as long as a year, leading to healthcare disparities, higher rates of disability and complications in chronic diseases,” CMS officials said in a 2016 press release. “SNC’s eConsult system has been proven to increase access to timely, cost-effective specialty services for underinsured and underserved patients, many of whom live in rural areas with limited access to specialty care.”


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