The agency offered insights to lawmakers on what we do and don’t know about emerging technologies that may improve beneficiaries’ access to healthcare.
In a report to Congress released Thursday, the Medicaid and CHIP Payment and Access Commission (MACPAC) made the case that telehealth has the potential to dramatically improve healthcare access but that many questions about the technologies remain unanswered.
As a nonpartisan legislative branch agency, MACPAC regularly offers its analysis and recommendations to lawmakers and policymakers. In its latest report—one of the two MACPAC is required by statute to deliver to Congress each year—the agency included a thorough discussion of telehealth and its potential applications for Medicaid beneficiaries.
“Although advances in technology offer great hopes for our ability to improve access to services in rural areas as well as to highly specialized services where the supply of providers is limited, evidence on the effectiveness and outcomes of telehealth is mixed,” MACPAC chair Penny Thompson, MPA, wrote in an opening letter.
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Almost every state and the District of Columbia offered some telehealth coverage in fee-for-service Medicaid last year, but the ways telehealth is currently used vary from state to state, according to MACPAC’s report.
Regardless, the agency identified five common themes that appear to apply nationwide:
1. Change is in the air.
The ways states cover telehealth in their Medicaid programs are shifting, MACPAC noted in its report.
“Over time, states have expanded coverage for telehealth and further expansions of coverage to new modalities, services, or specialties are likely,” the report states.
“In addition, ongoing advances in technology could lead to new opportunities for telehealth. As states consider how to improve access to care, they may consider a greater role for telehealth particularly in areas such as behavioral health or chronic disease management where the evidence of its effectiveness is relatively strong.”
2. More info about stakeholder experience is needed.
Policymakers and providers still have a lot to learn about the impact telehealth has on their own experiences and those of the Medicaid beneficiaries they serve, MACPAC said.
“For example, there is little information about outcomes and effectiveness, cost, or program integrity issues related to Medicaid coverage of telehealth-provided services,” the report states.
“Existing research and data on the use of some telehealth modalities for different health or clinical conditions or populations has not focused on Medicaid populations or programs. Moreover, findings have been inconclusive concerning telehealth’s effectiveness.”
3. It’s a bit like the Wild West.
The federal government has set few barriers to impede the use of telehealth in Medicaid programs; that being said, there are other obstacles that policymakers and payers should consider, MACPAC said.
“For example, access to technology and the broadband services required for telehealth can pose a challenge to some of the communities for which telehealth might be most beneficial,” the report states. "Examples of other commonly cited barriers to telehealth include licensure and ensuring privacy and security of personal information.”
4. Telehealth can’t solve everything.
Even if telehealth technologies solve some of Medicaid’s access-to-care problems, they won’t solve them all, MACPAC said.
“For example, telehealth can address geographic access barriers and make it easier or more convenient for beneficiaries to see a provider who already cares for Medicaid enrollees,” the report states, “but it will not guarantee a change in overall provider willingness to participate in Medicaid or issues such as the lack of convenient office hours and available appointment times.”
5. We need more research.
If a state wants to introduce or expand telehealth coverage in its Medicaid program, then it would likely find value in new research and reviewing the experiences of its peers in other states, MACPAC said.
“Shared state insights can also help other states, providers, health plans, and the research community gain a more robust understanding of the effects of telehealth on access to care, quality, and cost of care for the Medicaid population.”
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The full report—which includes a discussion of disproportionate share hospital (DSH) allotments and recommendations to streamline the process by which state programs are authorized—is available on the MACPAC website.
Steven Porter is an associate content manager and Strategy editor for HealthLeaders, a Simplify Compliance brand.