Assessing Telemedicine Utilization by Using Medicaid Claims Data

Abstract

Objective This study characterized telemedicine utilization among Medicaid enrollees by patients’ demographic characteristics, geographic location, enrollment type, eligibility category, and clinical conditions. Methods This study used 2008–2009 Medicaid claims data from 28 states and the District of Columbia to characterize telemedicine claims (indicated by GT for professional fee claims or Q3014 for facility fees) on the basis of patients’ demographic characteristics, geographic location, enrollment type, eligibility category, and clinical condition as indicated by ICD-9 codes. States lacking Medicaid telemedicine reimbursement policies were excluded. Chi-square tests were used to compare telemedicine utilization rates and one-way analysis of variance was used to estimate mean differences in number of telemedicine encounters among subgroups. Results A total of 45,233,602 Medicaid enrollees from the 22 states with telemedicine reimbursement policies were included in the study, and .1% were telemedicine users. Individuals ages 45 to 64 (16.4%), whites (11.3%), males (8.5%), rural residents (26.0%), those with managed care plans (7.9%), and those categorized as aged, blind, and disabled (28.1%) were more likely to receive telemedicine (p<.001). Nearly 95% of telemedicine claims were associated with a behavioral health diagnosis, of which over 50% were for bipolar disorder and attention-deficit disorder or attention-deficit hyperactivity disorder (29.3% and 23.4%, respectively). State-level variation was high, ranging from .0 to 59.91 claims per 10,000 enrollees (Arkansas and Arizona, respectively). Conclusions Despite the touted potential for telemedicine to improve health care access, actual utilization of telemedicine in Medicaid programs was low. It was predominantly used to treat behavioral health diagnoses. Reimbursement alone is insufficient to support broad utilization for Medicaid enrollees.

Patterns of Telehealth Use Among Rural Medicaid Beneficiaries

“…Few analogous studies have been conducted for Medicaid populations. Douglas and associates used 2008 and 2009 data to examine telehealth use among Medicaid beneficiaries and found that nonmetropolitan enrollees were 17 times more likely to receive telemedicine services than their metropolitan counterparts . In the present study, we extend previous work by providing more nuanced information on telehealth users in rural Medicaid populations.…”

“…Less than one‐tenth of 1% of this population accessed telehealth services, and telehealth visit volume amounted to 232 claims per 100,000 nondual eligibles (an estimated 133,860 claims in study states). A recent study by Douglas and associates found similarly low rates of telehealth use in the 2008–2009 Medicaid MAX. Additionally, published Medicare claims data for 2011 show that Medicare Part B beneficiaries received 254 telehealth visits per 100,000 beneficiaries…”

Developing Telemental Health Partnerships Between State Medical Schools and Federally Qualified Health Centers: Navigating the Regulatory Landscape and Policy Recommendations

“…There is a preponderance of evidence that TMH is effective across a wide range of diagnoses and populations . Though TMH is particularly well‐suited to delivering care from a distance, adoption has been negligible in Medicare, Medicaid, and the private insurance sector …”

“…4 Though TMH is particularly well-suited to delivering care from a distance, 5 adoption has been negligible in Medicare, Medicaid, and the private insurance sector. [6][7][8] TMH can be delivered with a range of intensities, from curbside consultation to referral for ongoing care. 9,10 The 2 most effective models of TMH are collaborative care and referral care.…”

Bipolar disorder and posttraumatic stress disorder in rural primary care: Extending specialty care reach

“…3 Our work in this case is in line with recent data showing among commercially insured individuals from 2005 to 2017, the majority of telemedicine visits were for mental health services, 4 that the delivery of telemental health services has increased more rapidly in counties with no psychiatrist, 4 and that approximately 30% of Medicaid claims for telehealth were for clinical encounters with a diagnosis code for bipolar disorder. 5 These reports suggest others in the United States are possibly addressing this same clinical conundrum using telehealth.…”