The State of Telehealth in Medi-Cal Managed Care

Never have the benefits and importance of expanding access to telehealth been more evident than they are now, in the midst of a global pandemic from COVID-19, given the evidence that human-to-human contact is considered to be the primary mode of transmission. Even in normal times, telehealth increases access to care by expanding options for patients to connect with providers and by significantly decreasing wait times between a referral and a subsequent visit. Its potential to help patients get the care they need when they need it is particularly great in Medi-Cal, California’s Medicaid program. Twenty-five percent of Medi-Cal enrollees report difficulty finding a specialist when they need one — a rate over two times greater than for Californians with employer-based coverage.

In 2019, the California Department of Health Care Services (DHCS), which administers Medi-Cal, expanded coverage for telehealth. In 2020, in response to the pandemic, state officials swiftly took additional action to expand access to telehealth, including allowing Federally Qualified Health Centers and other Medi-Cal providers to bill for phone visits and other visits that originate outside a clinical setting. Whether these changes are temporary or take root is unknown at this time.

Managed care plans (MCPs) are responsible for ensuring that more than 10 million Medi-Cal enrollees in managed care receive timely access to care. However, the extent to which Medi-Cal MCPs are using telehealth to improve access to care for their members has not been studied. This report provides a first look at the telehealth landscape among Medi-Cal MCPs, including a snapshot of use in 2019 and insight into the priorities, approaches, and challenges of MCPs in offering telehealth services to their members. The findings reflect surveys completed by 17 of the 24 Medi-Cal MCPs, representing 88% of Medi-Cal managed care enrollees and all three plan types: County Organized Health Systems, local initiative health plans, and commercial plans.

Key Findings

1. Across most MCPs, member and provider use of telehealth across modalities is low.

Key Findings

1. Across most MCPs, member and provider use of telehealth across modalities is low.

 

2. MCPs are confident telehealth will improve specialty care access, member satisfaction, and care coordination.

3. MCPs point to several barriers to the broader use of member-to-provider telehealth.

Nine other key findings, with accompanying charts, can be found in the full report under Document Downloads.

Methods

In July 2019, BluePath Health sent an online survey to all 24 Medi-Cal MCPs about their perspectives on and experience with telehealth. Over a three-month period, 17 MCPs completed the survey, and 14 MCPs agreed to participate in follow-up interviews to elaborate on their responses and to share additional insights. MCPs that completed the questionnaire represent over 88% of Medi-Cal managed care enrollees and include four of the six County Organized Health Systems, six of the nine local initiative health plans, and seven of nine commercial MCPs. MCPs were asked to include only their Medi-Cal business line when answering the questionnaire. One MCP responded by including all lines of business, as they are unable to report Medi-Cal-specific data. All survey responses were self-reported, and none were independently verified. See the full report for a list of participating MCPs.