Exploring Equitable Access to Care and Outcomes Using Telehealth in the Transition to Medicaid Managed Care

Exploring Equitable Access to Care and Outcomes Using Telehealth in the Transition to Medicaid Managed Care


Overview

The shift to Medicaid Managed Care and value-based payment may disrupt care networks and inadvertently create new barriers to equitable, timely, person-centered care. While telephonic outreach and virtual visits (hereafter telehealth) can enable trusting patient-provider relationships for high quality care, the use of telehealth in new care arrangements may not be feasible, acceptable, or appropriate with all populations. Payment reform for telehealth use with NC Medicaid beneficiaries in 2020 creates the ideal scenario for studying current practice to inform Medicaid Managed Care.

Our overall goal is to establish data-driven policy that advances equitable care and outcomes for Medicaid beneficiaries. We will apply econometric methods to NC Medicaid claims data and estimate disparities in access and outcomes by examining in-person, telephonic, and virtual visits from 2018-2021. Using interviews, listening sessions, and convenings with patients/caregivers, clinicians, administrators, payers, and policymakers, we will explore barriers and experiences with telehealth and further expand our understanding of contributors to observed disparities. Our findings will generate context-specific interventions and clinical, payment, and regulatory options to optimize remote care delivery and payment to facilitate health for financially disadvantaged and historically marginalized North Carolinians.

 

Populations of Focus

We will study Medicaid-insured children and adults identified to be living with behavioral health or musculoskeletal (MSK) disorders (e.g., back pain). Within these disease categories, we seek to maximize involvement among immigrant and non-native English-speaking communities, individuals of different race/ethnicities, and representing different geographies. It is critical that we study disparities in access and outcomes, incorporating the lived experience, to inform policies that shape population health.

 

Funding

Funding for this project is provided by the Kate B. Reynolds Charitable Trust.

Duke-Margolis Affiliated Research Team Members

Janet Prvu Bettger

Janet Prvu Bettger, ScD, FAHA

Director of Undergraduate Education and Research Initiatives, Margolis Center
Margolis Core Faculty
Associate Professor of Orthopaedic Surgery
2020 Intern Mentor
Anti-Racism and Equity Committee Member

whitaker

Rebecca Whitaker, PhD, MSPH

Assistant Research Director
Senior Team Member
Anti-Racism and Equity Committee Member

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Rushina Cholera, MD

Medical Instructor in the Department of Pediatrics
2020 Intern Mentor
Anti-Racism and Equity Committee Member

Susan Dentzer

Susan Dentzer

Senior Policy Fellow

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Salama Freed, PhD

Postdoctoral Health Policy Fellow

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Jessica Genova, MPH

Project Manager

Lucas Stewart Headshot

Lucas Stewart, MPP

Data Analyst Programmer

Abhigya Gigi Headshot

Abhigya Giri, MPH

Data Analyst Programmer

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Nadia Bey, (BA/BS '23)

2021 Margolis Intern
Margolis Scholar

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Cynthia Dong, (BA/BS '23)

2021 Margolis Intern
Margolis Scholar

Ana DeCesare

Ana DeCesare

2021 Margolis Intern

Additional Research Team Members and Key Collaborators

 

  • Gary Maslow MD, Duke University Department of Psychiatry and Behavioral Sciences

  • Karen Swietek PhD, NORC at the University of Chicago

  • Alexis French PhD, Duke University Department of Psychiatry and Behavioral Sciences

  • Kelley Jones PhD, Duke University Department of Population Health Sciences

  • Ashley Lake DPT, PT, SCS, Duke University Department of Physical Therapy & Occupational Therapy

  • Annise Weaver MSEd, CRC, Associate Director of Diversity, Equity and Inclusion, Duke University Department of Psychiatry and Behavioral Sciences

  • Duke NIH Clinical and Translational Science Award (CTSA) Community Engaged Research Initiative team, including:

    • L. Ebony Boulware MD, Director for Duke Clinical and Translational Science Award

    • Leonor Corsino MD, Rosa Gonzalez-Guarda PhD, Mina Silberberg PhD, Julius Wilder MD PhD, Co-Directors for CTSA Community Engaged Research Initiative

    • Eve Marion, Research Program Leader

    • Sabrena Mervin-Blake, Senior Staff Director

    • Kiah Gaskin MPH MSW, Research Program Leader

    • Daphne Lancaster, Program Coordinator