May 4, 2016
Offering virtual dermatology care to Medicaid recipients can sharply increase use of dermatology services, offering one potential way to increase access to medical specialists who are in short supply, according to a new RAND Corporation study.
Researchers found that after the introduction of a teledermatology service, the number of patients who received care from a dermatologist nearly doubled, with greater utilization of dermatology care among patients treated in primary care practices that began using the service, as compared to patients seen by primary care practices that did not use the teledermatology service.
The study found that teledermatology generally served younger and healthier patients who had more-targeted and potentially less-severe skin conditions, such as acne and warts. The findings are published in the May edition of the journal JAMA Dermatology.
"While in-person dermatologists served many of the patients with the greatest medical need, teledermatology expanded access to a new group of enrollees with different demographics and different needs," said Lori Uscher-Pines, the study's lead author and a policy researcher at RAND, a nonprofit research organization. "Our findings show that among at least one large population of Medicaid patients, teledermatology can improve access to medical specialists."
Researchers analyzed the experiences of more than 380,000 Medicaid enrollees in California's Central Valley, including about 108,000 who were newly enrolled under provisions of the Affordable Care Act. The region has only about one-third as many dermatologists per 100,000 residents as the national average (1.2 vs. 3.6).
The Health Plan of San Joaquin, a MediCal managed plan, began offering teledermatology to its members in April 2012, although not all of the primary care practices in the system began referring patients to the service. (Medicaid is called MediCal in California.)
The novel teledermatology model implemented in the Health Plan of San Joaquin involved both consultative and direct-care elements. Some primary care physicians who referred patients to teledermatology provided background about patients and took digital images of skin problems, which were uploaded to a secure Website. They then received a consult report within a few days.
However, over time most primary care practices that referred patients to teledermatology used a more direct-care model. Patients with skin problems were referred by their physician to two brick-and-mortar clinics to have photographs taken and to be interviewed by a teledermatology nurse.
The remote dermatologist then reviewed the history and images, with the diagnosis and treatment relayed to both the patient and referring primary care provider. If necessary, an in-person follow-up visit was scheduled at the clinic, where a teledermatologist was regularly onsite.
The study found that patients in primary care practices that were referred to teledermatology were more likely to have one or more visits with a dermatologist and the rate of visits with dermatologists also increased.
After it was introduced, teledermatology served half of all enrollees who received any dermatology care. Among those newly enrolled under the Affordable Care Act, teledermatology served three-quarters of patients with any dermatology care in 2014. People who had more-complex problems such as psoriasis and skin cancers were more likely to visit a dermatologist in-person than other patients.
While the initial use of teledermatology was to increase use of dermatology care, researchers say that in the future the approach may be used to substitute for in-person visits as a way of reducing costs and increasing convenience for patients.
Future research on teledermatology should assess the quality of services provided, as well as the satisfaction of patients and referring professionals with the model, according to researchers.
Support for the study was provided by the California Health Care Foundation. Other authors of the study are Rosalie Malsberger, Lane Burgette and Andrew Mulcahy of RAND, and Ateev Mehrotra of RAND and the Harvard Medical School.
RAND Health is the nation's largest independent health policy research program, with a broad research portfolio that focuses on health care costs, quality and public health preparedness, among other topics.