Evaluating an Equity-Focused Telehealth Delivery Model for Medicaid-Enrollees at Federally Qualified Health Centers.

The COVID-19 pandemic has transformed the primary care landscape with rapid shifts to telehealth. For low-income patients enrolled in Medicaid, telehealth may have wide-ranging impacts on the value and equity of care. It may lower costs and improve access for patients who previously experienced barriers to in-person visits. However, telehealth could exacerbate disparities, particularly for patients with inadequate access to technology or the internet, or for whom English is not their primary language.

In partnership with Community Care Cooperative (C3)—the largest Federally Qualified Health Center (FQHC) Accountable Care Organization (ACO) in the US—this study: (1) evaluates the effects of telehealth on utilization of health care services, quality outcomes, and spending among Medicaid-enrolled patients at C3 FQHCs; (2) assesses heterogeneity in effects across racial/ethnic and linguistic subpopulations; and (3) identifies scalable best practices for optimizing value and equity of telehealth in low-income populations. Boston University School of Public Health, led by Dr. Megan Cole, PhD, MPH, leads the study using quasi-experimental methods to analyze electronic medical record, claims data, and patient survey data. It is led in partnership with Dr. June-Ho Kim, MD, MPH and Ariadne Labs, which brings its extensive experience in qualitative research and implementation science and apply its proven model for designing scalable solutions for national spread.

Evidence from this research will be integrated into C3’s Medicaid ACO network of 18 FQHCs and across the 35 FQHCs within the Massachusetts FQHC Telehealth Consortium. Evidence from this study will also inform the development of the state’s next 1115 waiver, which will include a comprehensive, capitated primary care model that incorporates telehealth while addressing the physical, behavioral, and social needs of Medicaid-enrollees.