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How has telemedicine impacted healthcare disparities for Medicaid beneficiaries?

A team of researchers at the Tulane School of Public Health and Tropical Medicine has been awarded a $120,000 from the Commonwealth Fund to conduct a series of studies to determine the impact of the rapid transition to telemedicine in the wake of COVID-19 on Medicaid beneficiaries in Louisiana.

By late March 2020, Louisiana’s Governor John Bel Edwards had ordered residents to shelter-in-place in response to what was then the fastest growth rate of COVID-19 in the world. This shutdown extended to healthcare providers, who deferred elective and preventive visits to minimize patient and provider exposure to the virus.

In response to the shutdown, the Centers for Medicare and Medicaid Services eased regulations on the use of telemedicine, or the remote delivery of healthcare services using telecommunications, for Medicare beneficiaries, with additional guidance for state Medicaid and CHIP programs to ensure access to necessary care.

In Louisiana and throughout the U.S., telemedicine is not widespread among Medicaid beneficiaries and other vulnerable patient populations. Barriers include a lack of appropriate technology, unreliable or unavailable internet coverage, and poor digital literacy. Preliminary data suggests that there are even further disparities in the use of telemedicine by race and ethnicity, as well as age.

Dr. Brigham Walker, research assistant professor in the Department of Health Policy and Management, will serve as principal investigator on the project. Together with co-investigators Dr. Kevin CallisonDr. Andrew Anderson, and Dr. Thomas LaVeist, Walker will conduct a series of analyses using Medicaid claims data maintained by the department in partnership with the Louisiana Department of Health. The data are refreshed monthly, giving the researchers a near real-time picture of service utilization for the state’s Medicaid population.

The team’s first goal will be to estimate the effect of COVID-19 on the use of telemedicine services and on the disparities in utilization for Medicaid beneficiaries. While they expect to see an increase in the use of telemedicine by Louisiana Medicaid beneficiaries, they want to determine if there disparities in use by race and age. They will also study the effect of COVID-19 on care quality for the Medicaid population using performance measures commonly used in quality improvement and payment programs.

— By Dee Boling