Addressing Inequities in Access to Care for Patients with Hematologic Malignancy: Understanding the Impact of Telehealth Policies in Medicaid
Anushree Vichare
PhD, MBBSThe George Washington University
Project Term: July 1, 2024 - June 30, 2027
Telehealth could improve access for Medicaid patients with a blood cancer who experience barriers to specialty care, but not all specialists offer it. Using Medicaid data, this study will provide novel information on whether blood cancer specialists are continuing to use telehealth following the COVID-19 pandemic when telehealth use increased dramatically. This study will also examine if telehealth helps address inequities in access to specialists, including for racial/ethnic minoritized groups and those living in rural areas.
Existing inequities in access to cancer care, particularly among groups vulnerable to disparities (e.g., low-income individuals, racial/ethnic minoritized groups, those living in rural areas), may be exacerbated due to growing demand for oncologic care along with predicted shortages in the oncology workforce. Evidence suggests that telehealth can be an innovative and effective model to improve access to care for patients with a blood cancer. However, the extent of telehealth utilization by Medicaid beneficiaries with a blood cancer remains unknown. Further, variations in state Medicaid telehealth coverage and payment policies may affect the provision of telehealth services by hematology oncologists, but this question remains unexplored. This study will implement an observational study design using the newly available national-level Medicaid claims data over an 8-year period (2016-2023) linked longitudinally to obtain detailed information on Medicaid beneficiaries’ healthcare utilization. Telehealth provision by the “specialists” to Medicaid patients with hematologic malignancies will be observed, with a specific focus on identifying differences in telehealth uptake among vulnerable populations such as racial/ethnic minoritized and rural patients. This study will also examine how recent legislative changes in telehealth coverage and payments under Medicaid impact access to telehealth. By including patients covered by Medicaid, the findings from this study will provide first-known estimates on patterns of telehealth utilization by these patients and inform strategies to improve telehealth access through policy reforms.