States Explore Emerging Evidence to Learn New, Innovative Uses of Telehealth

The National Academy for State Health Policy (NASHP) recently launched the Telehealth Affinity Group, composed of state policymakers, that is examining emerging evidence from the Patient-Centered Outcomes Research Institute (PCORI) into innovative uses of telehealth to transform health care delivery systems in states.

State and federal policymakers are eager to explore emerging patient-centered outcomes research about new uses for telehealth beyond traditional care delivery, but they need additional information to evaluate PCORI studies and effectively apply their findings to the populations they serve.

For this study, a working group of parents and stakeholders from Federally Qualified Health Centers (FQHCs) and Community Mental Health Centers (CMHCs) in Los Angeles County designed a new referral process called the Telehealth-Coordinated Referral:

  • After receiving a referral for mental health care from an FQHC, parents watched a five-minute video introducing them to the referred CMHC.
  • At a follow-up appointment, the parent/s and child undergo the CMHC eligibility screening via a live teleconference with CMHC staff facilitated by a telehealth care coordinator, which is a new position funded by the grant.

States are motivated to implement telehealth policies that expand access to care and offer innovative approaches to care delivery. The importance of the topic is reflected in the robust investments that PCORI has made in its telehealth research portfolio. As of August 2019, PCORI has invested $381 million to support 88 comparative clinical effectiveness research studies in telehealth.

NASHP’s affinity group members represent nine states and a range of agencies, including Medicaid, state employee health plans, departments of insurance, offices of delivery system transformation, and departments of public health. These state officials offer extensive experience and expertise into telehealth and health care system innovations. The first convening of the group took place in August at NASHP’s 32nd Annual State Health Policy Conference in Chicago, where officials discussed a PCORI-funded study on a telehealth intervention that targeted behavioral health.

The study examined efforts to improve the mental health care referral process for children enrolled in Medicaid in Los Angeles County. This is how the intervention works:

  1. The primary care provider refers parent/s to a Community Mental Health Centers (CMHC).
  2. The parent/s watch a brief introductory video about the referred CMHC.
  3. The family then undergoes an eligibility screening through a teleconference (video chat) with a CMHC staff member during a follow-up appointment at their Federally Qualified Health Center (FQHC). 

Compared with parents who had traditional referrals and screenings conducted over a follow-up phone call, the parents who watched the video and were screened by video chats at the FQHC were three-times more likely to complete the screening.

Patient-centered telehealth research, like this PCORI study, can help policymakers evaluate telehealth through a broader lens. Affinity group members explained that they often think of telehealth as “use of telecommunication technology to provide delivery of health care services,” but this study focused on telehealth as a tool to improve referrals and increase access to new services. As indicated by this study, new telehealth policies or investments may not necessarily dramatically change care delivery, but can greatly improve access or streamline existing processes.

Officials welcomed the opportunity to think about new and different uses of telehealth, and noted that telehealth can help address the practical challenges of any type of medical referrals – such as following up with providers or finding transportation to new health center locations – which can be even more onerous for families enrolled in Medicaid. Policymakers noted the study’s intervention offered a unique telehealth solution to referral challenges by creating a “warm,” technically streamlined hand-off between provider entities. The intervention also allowed new providers to connect with a family in a familiar location that the family already knew and trusted.

When considering new evidence, policymakers are interested in the return on investment (ROI) an intervention can provide. This is especially true in the case of telehealth interventions as substantial costs may be involved in setting up the technology infrastructure needed for its launch. For example, based on this study, affinity group members indicated it would be useful to understand the ROI of increased mental health care screening and subsequent access in order to make the case for funding the staffing and infrastructure needed for a similar intervention at an FQHC. Better understanding the challenges and context that a study addresses is also helpful for state officials who are considering emerging telehealth research. For example, members noted that reviewing the PCORI study alongside additional research findings into the importance of mental health care for young patients could enhance their understanding of how this study could be applied to future policy initiatives.

The cross-agency membership of the affinity group represents diverse patient interests, and when faced with new evidence, members are interested in how an intervention could effectively apply or translate to the specific populations they serve.

  • Those representing commercially insured patients were interested in learning how this intervention could be implemented in the commercial sector. 
  • Officials serving rural communities and areas with provider shortages wondered if the intervention could include actual care delivery in another iteration to overcome access challenges. 

Affinity group members also noted there was a lack of clarity on what specifically made this intervention successful — was it the introductory video, eligibility screening via teleconference, or having an additional staff member focused on the referral process? When considering how to implement new evidence-based approaches in their states, policymakers want to know which part of an intervention might be most impactful so they can effectively target populations and make the case for any related policies and investments.

When presenting new evidence on telehealth, researchers could improve the applicability of their findings by:

  • Clearly describing the demographics of the population targeted in a study, including age, income, health status, etc.; 
  • Presenting contextual evidence to show the scope of the problem that an intervention seeks to address and the potential ROI of addressing the challenge; and
  • Differentiating which part of a studied intervention is most effective and might be most successful if implemented in a policymaker’s community.

NASHP’s Telehealth Affinity Group will continue to meet and discuss emerging PCORI research on telehealth in the coming months. Affinity group members are interested in exploring new studies using telehealth to address behavioral health needs. Future blogs will highlight the group’s discussion of policy implications of new research into this topic and others.