Positive Results from Medicaid Care Coordination Program

For any patient, the world of specialty care can be a challenging one to navigate. That can be particularly true for Medicaid patients in need of specialist care, given that they often face long waits for appointments, with a limited pool of providers willing to treat them. But one telehealth program has demonstrated tremendous success in patient care coordination by connecting primary care providers with specialists online. As mHealth Intelligence first reported, the Community Health Center eConsult program, which was developed and piloted in Connecticut, allows primary care physicians to communicate online with specialists about the necessity of patient referrals. Today, the program “is reducing unnecessary spending, improving care coordination for the hard-to-reach Medicaid population, and making primary care doctors more confident in their abilities.”

The program’s developers shared highlights of their successes at the recent NETRC Conference, noting that the program is now in use in nine states—and eligible for Centers for Medicare and Medicaid Services (CMS) reimbursement. It began with a pilot program for care coordinators of Medicaid cardiac-care patients; specialists would refer case details sent by primary care providers before making the decision as to whether or not a referral was needed. Notably, the results showed “that almost 70 percent of the specialty referrals didn’t require an appointment with a specialist.” Specialists could also provide primary care providers with guidance about suggested treatments.

Notably, this is only the latest mobile health venture to focus on Medicaid patients. Earlier this spring, we highlighted a new Harvard Medical School partnership with mobile health company mPulse. One of two planned mHealth programs would target new Medicaid enrollees, with the goal of connecting them with primary care providers—often a complicated process, but a vitally important one. Many of those first entering Medicaid face language barriers and other challenges, making the process even more daunting; to that end, with the new Harvard/mPulse program, “tailored text messaging aims to determine how language barriers affect a member’s ability to actively seek out chronic care.” The second program is aimed at Medicaid patients with chronic conditions; through interactive text messages, program staff will take steps to encourage patients to participate in disease management initiatives, which can lead to better adherence to treatment and, in turn, better health outcomes.

Click here for the article from mHealth Intelligence on the care coordination program for Medicaid patients.


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