May 4, 2016
Published in: JAMA Dermatology, 2016
Posted on RAND.org on May 19, 2016
IMPORTANCE: Access to specialists such as dermatologists is often limited for Medicaid enrollees. Teledermatology has been promoted as a potential solution; however, its effect on access to care at the population level has rarely been assessed. OBJECTIVES: To evaluate the effect of teledermatology on the number of Medicaid enrollees who received dermatology care and to describe which patients were most likely to be referred to teledermatology. DESIGN, SETTING, AND PARTICIPANTS: Claims data from a large California Medicaid managed care plan that began offering teledermatology as a covered service in April 2012 were analyzed. The plan enrolled 382 801 patients in California's Central Valley, including 108 480 newly enrolled patients who obtained coverage after the implementation of the Affordable Care Act. Rates of dermatology visits by patients affiliated with primary care practices that referred patients to teledermatology and those that did not were compared. Data were collected from April 1, 2012, through December 31, 2014, and assessed from March 1 to October 15, 2015. MAIN OUTCOMES AND MEASURES: The percentage of patients with at least 1 visit to a dermatologist (including in-person and teledermatology visits) and total visits with dermatologists (including in-person and teledermatology visits) per 1000 patients. RESULTS: Of the 382 801 patients enrolled for at least 1 day from 2012 to 2014, 8614 (2.2%) had 1 or more visits with a dermatologist. Of all patients who visited a dermatologist, 48.5% received care via teledermatology. Among the patients newly enrolled in Medicaid, 75.7% (1474 of 1947) of those who visited a dermatologist received care via teledermatology. Primary care practices that engaged in teledermatology had a 63.8% increase in the fraction of patients visiting a dermatologist (vs 20.5% in other practices; P < .01). Compared with in-person dermatology, teledermatology served more patients younger vs older than 17 years (2600 of 4427 [58.7%] vs 1404 of 4187 [33.5%]), male patients (1849 of 4427 [41.8%] vs 1526 of 4187 [36.4%]), nonwhite patients (2779 of 4188 [66.4%] vs 1844 of 3478 [53.0%]), and individuals without comorbid conditions (1795 of 2464 [72.8%] vs 1978 of 3024 [65.4%]) (P < .001 for all comparisons). Conditions managed across settings varied; teledermatology physicians were more likely to care for viral skin lesions and acne (3405 of 7287 visits [46.7%]), whereas in-person dermatologists were more likely to care for psoriasis and skin neoplasms (10 062 of 27 347 visits [36.8%]). CONCLUSIONS AND RELEVANCE: The offering of teledermatology appeared to improve access to determology care among Medicaid enrollees and played an especially important role for the newly enrolled.