Managed Care Patients using Medicaid See Benefits from eConsults

​Medicaid and Medicaid recognize the benefits of managed care for patients. Managed Care is vital to our communities and population’s health and well-being. April is Medicaid Awareness Month, and we want to share some important facts about the impact of Medicaid coverage and the benefits telehealth systems can offer—such as an eConsult platform—to provide services to this patient population more effectively.

At a glance:

• Only 41% of specialists accepted Medicaid in 2017 in 15 major metro areas across four major specialties—the same study showed only 33% of dermatology specialists took Medicaid!
• Nearly 35 million children are enrolled in Medicaid and CHIP, and Medicaid covers 39% of children in America.
• Nearly 1 in 3 seniors live 200 percent below the federal poverty line. For many of these seniors, Medicaid is a critical lifeline.
• Medicaid funds 53 percent of long-term care nationwide. As seniors age, long-term care services become more and more vital, serving half of seniors over age 75 and 75% of seniors over age 85.
• 7 million nonelderly adults with disabilities depend on Medicaid for care. Of this group, only 43% qualify for social security income.

Telehealth solutions can potentially deliver the benefits of managed care for patients while mitigating barriers to proactive health management for Managed Care populations, such as an insufficient supply of providers accepting Medicaid, inadequate transportation options, and long distances and associated travel time, particularly for patients in rural areas. It also may help dissuade patients’ concerns about confidentiality and stigma, particularly for behavioral health services.

eConsults—a method of asynchronous telehealth communication—breakdown access barriers and get timely specialty care for our most vulnerable populations, delivering access within the primary care setting. eConsults bring the benefits of managed care for patients by connecting PCPs with specialists in over 70 specialty and subspecialty areas, including pediatric subspecialties, which empowers providers to deliver more comprehensive care and better manage complex and costly patient populations. This novel solution reduces negative downstream effects (presenting in the ED, becoming higher acuity) related to patients waiting weeks to find an office that accepts Medicaid.

In addition, eConsults remove wait times and transportation burden, delivering the timely care patients need at the primary care site they are already visiting. Unlike traditional telehealth, patients do not need to travel to an originating site or navigate complex technology. All information exchanged occurs between providers, with no burden on the member.

eConsults deliver care without additional travel for members with disabilities, behavioral health disorders, or those with other social barriers complicated by having to make additional physician office visits. PCPs caring for nursing home or home-bound patients get timely access to specialty care without leaving the patient site.

Key eConsult Benefits for Medicaid Managed Care Stakeholders:

Lower the cost of care—for payers and patients

• Eliminate over 70% of unnecessary specialist visits, allowing PCPs to retain patients for routine clinical concerns and avoiding more expensive specialist visits and related workups
• Reduced wait times to see a specialist result in avoiding unnecessary ED visits, ensuring patients with critical needs get treatment more quickly.
• PCPs can develop specialist-guided treatment plans sooner, avoiding unnecessary medical costs resulting from delayed care
• eConsults support PCPs in succeeding within value-based care reimbursement models —meeting quality measures, improving care coordination, and managing the overall cost of care

Learn more about telehealth reimbursement, including CPT codes for eConsults, virtual check-ups, and remote patient monitoring (RPM): CMS reimbursement changes in healthcare include expansion for telehealth platforms, including eConsults

Improved member satisfaction

• Provide more timely access to specialty care
• Reduce out-of-pocket (OOP) expenses, including appointment OOP costs, transportation, missed work, and childcare
• Encourage patients to manage their health through convenient care within the primary care setting
• Improve the experience of timely and thorough care coordination

Improved provider experience

• Increase PCP satisfaction by providing timely and streamlined access to specialists in under 24 hours
• Reduce no-show rates to specialists (40% or higher in many instances)
• Better triage of referrals means face-to-face visits are preserved for higher acuity patients who need it most—improving specialist satisfaction