The University of California at Los Angeles (UCLA)’s Center for the Study of Latino Health and Culture has released a report with policy recommendations to ensure access to high-quality care for vulnerable populations through telehealth, including ensuring coverage and access to medical interpreters.
The UCLA report notes that the COVID-19 pandemic has brought to light shortcomings of existing telehealth infrastructure and the inefficiencies in existing reimbursement rules. “Especially hard hit have been safety-net clinics serving medically underserved and rural areas, many facing alarming drops in Medicaid and Medicare reimbursements as a result of the drop in face-to-face consultations,” the report notes.
Many rural and underserved patients lack internet service or devices to support virtual visits, and many providers lack broadband connectivity and equipment.
The report zeroes in on the potential for using telehealth in Medi-Cal, California’s Medicaid program. Medicaid managed care plans are investing to expand the use of telehealth to improve access to care, quality of care, and member and provider satisfaction. “Ensuring the provision of quality care for linguistically and medically underserved populations may require standardized reporting across MCPs on access, utilization, and MCP measurement of outcomes for enrollees. However, care will need to be taken to prevent increased administrative burden on already overwhelmed primary care physicians,” the report says.
Culture, needs, and population demographics must be accounted for when designing telehealth services. “As California’s Latino community continues to grow and make up the largest racial/ethnic population, it must be the central focus during the development of these technological interventions,” the report states, adding that in California, nearly 44 percent of the population speaks a language other than English at home, and Spanish-speaking physicians are the most under-represented in the physician workforce. “Medical interpreter use will need to be systematically incorporated into telehealth technology to ensure language-concordance is addressed.”
In addition, the report stresses that guidance and technological troubleshooting are imperative in ensuring access to telehealth services for those with limited technological literacy.
After noting several positive changes that have been made regarding telehealth reimbursement, the report states that “clearer guidance on billing and reimbursement policies across payers is much needed. Additionally lacking is payer consistency in “evaluation and management” service reimbursement for telephonic encounters, which are fundamental to providing care to patients in the safety-net through the expected length of this pandemic.”
The UCLA team recommends more research be done to determine which Medi-Cal managed care plans are using telehealth to improve access to care for their members and to examine patient experience in accessing care. “The development of evaluation measures for telehealth programs is needed to assess telehealth services’ ability to effectively provide quality clinical services, and to evaluate its safety, availability, and accommodation of care for limited-English proficient populations.”
Among its other recommendations, the UCLA team suggests expanding telehealth services in specialty care, including hospice care, behavioral health specialists, and chronic care management, and ensuring coverage and access to medical interpreters. “Consideration should be given to expedited training and certification for healthcare interpreters during this public health emergency.”
