The Role of Telehealth in Improving Access to and Costs of Unscheduled Care Among Lower-Income Individuals

PI: Lindsay Allen, PhD, assistant professor of Emergency Medicine

Immediate (or “urgent”) care treats injuries or illnesses that lie between primary and emergency care. During the COVID-19 pandemic, virtual immediate care made up the largest share of visits in the new, expanded telehealth infrastructure. The rise of virtual immediate care has important implications for health care access and costs, especially among those with Medicaid. Access to and costs associated with immediate care are especially important considerations for this marginalized group, who are less likely to engage in primary care, rely more heavily on expensive emergency department care for non-urgent conditions, and use more immediate care than those with higher incomes.  

Though virtual care is widely thought to increase care access and reduce costs, there are well-documented reasons to believe that these benefits might be offset among Medicaid enrollees. For example, those with lower incomes are less likely to have broadband access, rendering virtual care largely inaccessible. When it comes to spending, shifting urgent care visits away from the emergency department represents an important cost-savings opportunity. However, telehealth visits may also increase costs, by acting as a complement to in-person care, rather than a substitute, and by inducing new demand that otherwise would not have occurred. Further complicating the picture, the impact of virtual immediate care on access and costs likely differs across different types of telehealth models, and across different marginalized subpopulations (e.g., those living in rural areas, racial and ethnic minority groups, individuals with special health care needs, and women). 

To date, no study has measured the impact of virtual immediate care among Medicaid enrollees. Yet, state Medicaid agencies face important decisions on whether to permanently extend COVID-era telehealth policies. Our study’s purpose is to generate urgently needed evidence to inform the policy conversation regarding telehealth and Medicaid, curating results that will be immediately useful to policymakers. Using a mixed-methods approach, we will conduct quantitative analyses using extensive health record data from major health care systems across three states, followed by stakeholder interviews with both Medicaid administrators and health systems leaders. Our aims are 1) Measure the impact of different telehealth delivery models on immediate care access and use among low-income individuals, overall and by subpopulations; 2) Calculate the impact of different virtual immediate care delivery models on health care episode costs, accounting for downstream care and new health care use that would not have otherwise occurred, overall and by subpopulations; 3) Conduct semi-structured interviews with Medicaid administrators and health system leaders to transform study results into practicable knowledge for policymakers. 

Learn more about this project.