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 studied 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 sought 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.

Virtual Town Hall

In May 2022, our research team hosted a virtual town hall to share research findings. During the town hall, our research team shared patients’ and health care providers’ experiences with accessing and delivering care via telehealth. Invited guests discussed and explored opportunities to use research findings to design community-specific solutions to reduce health inequities and improve health outcomes for people enrolled in Medicaid. Click here to find out more about our town hall. 

Fact Sheets

The fact sheets below summarize our research findings on access to health care and telehealth use among North Carolina's Medicaid beneficiaries with behavioral health (BH) and musculoskeletal (MSK) health conditions during the COVID-19 pandemic. 

Fact Sheet #1: Access to Health Care and Telehealth Use among North Carolina's Medicaid Beneficiaries with Behavioral Health Conditions

Fact Sheet #2: Access to Health Care and Telehealth Use among North Carolina's Medicaid Beneficiaries with Musculoskeletal Health Conditions

Explainer Videos

These videos were created by the Duke-Margolis Center for Health Policy through a project funded by the Kate B. Reynolds Charitable Trust.  These videos are Duke-Margolis products and are to be used for educational purposes only, and not for commercial purposes. For more information about the project and/or how to use these videos appropriately, please contact Yolande Pokam. 

Telehealth Disparities Explainer Video for Policymakers and Clinicians

Telehealth Disparities Explainer Video for the Broader Community

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

• Piedmont Health Services

• Word Tabernacle Church

• The Robeson County Partnership for Children

• The Parents as Teachers Program led by the Robeson County Health Department