Mei Wa Kwong

Helping Californians achieve equitable access to health care – California Health Care Foundation

Mei Wa Kwong, executive director of the Center for Connected Health Policy. Photo: Andri Tambunan

When COVID-19 broke out in 2020 and Americans were told to stay home, telehealth services became a crucial option for obtaining healthcare. For countless people who needed health services but had to limit in-person contact to avoid the coronavirus, telehealth was a lifeline. This meant they could see their healthcare professional remotely and the provider could be paid for the visit.

In California, even before the COVID-19 pandemic, telehealth policies were among the strongest in the country. The California Department of Health Services (DHCS) then took those rules one step further with temporary pandemic policies. The goal was to ensure telehealth services would be accessible so Californians could stay in touch with their healthcare providers while staying safe. Their choices have been embraced by the public and health care providers. Lawmakers and Gov. Gavin Newsom made those changes permanent starting in 2023 for Medi-Cal, the state’s Medicaid program that serves 14.6 million low-income or disabled people.

I recently interviewed Mei Wa Kwong, JD, executive director of the Sacramento-based company Center for Connected Health Policy (CCHP), on the far-reaching impact of these telehealth policies and their implications for the future of health care in California. CCHP is a non-profit, non-partisan group that aims to maximize the potential of telehealth to improve health outcomes, care delivery and cost-effectiveness. Our conversation has been edited and condensed for clarity.

Q: What will change for healthcare providers and patients when the permanent policies go into effect on January 1?

A: Not everything has changed. California has retained key policy relaxations that were temporarily put in place due to COVID-19. Providers will be paid for audio-only visits — typically phone conversations — at the same rate as in-person visits with some exceptions. However, there are other telehealth policies that are completely new and may impact access to telehealth in the future. For example, DHCS requires that providers, with some exceptions, not rely solely on audio-only tours and offer live video as an option no earlier than January 1, 2024. This requirement could be an issue for providers burdened with connectivity issues. , such as clinics in remote locations. Some providers who are unable or unwilling to meet the live video requirement may decline to be a Medi-Cal provider, which could mean less provider availability. The DHCS rule will only apply to care provided to those enrolled in Medi-Cal, not those enrolled in private health insurance plans.

Another Medi-Cal-only rule requires patients to complete additional consent forms regarding telehealth options to ensure enrollees understand their right to choose between telehealth or an in-person visit. DHCS will need to ensure that all registered providers using telehealth understand these new consent rules and expectations.

Q: Why was it so important for California to make temporary telehealth policies permanent?

A: Many Californians struggle to access services due to transportation barriers and provider shortages in their area. For them, access to robust telehealth services means they no longer have to miss work or leave family members behind due to the need to travel long distances for treatment. .

But it is not enough to extend the emergency telehealth rules that have been adopted during the pandemic. Many patients have limited access to the broadband services needed for video calls. Others may have computers and broadband, but lack the know-how to configure them for video calls.

Some healthcare providers in rural or low-income areas may also not have broadband access or employ staff who need assistance using video telehealth technology.

Had the DHCS completely reversed the temporary COVID-19 telehealth policies at the end of the public health emergency, some segments of the Medi-Cal population may have experienced decreased access to care. The DHCS wanted to avoid this.

Q: What are the obstacles to meeting the different deadlines of 2023 and 2024?

A: More detail on how to implement the policies is needed to ensure success. There are only a few months left to gather stakeholder feedback, develop guidance, educate vendors, provide technical assistance, and create reasonable exceptions before most of these policies take effect on January 1, 2023. new consent rules, other policies need to be developed. specific guidelines and policies that DHCS says would have exceptions available. However, other than the limited exceptions for patients established via an audio-only visit, we do not have relevant details regarding other exceptions or how the various policies will be implemented. The wording of these elements will be essential to ensure compliance. Developing directions for new policies will take time, and there is little time left.

The first step is to engage with stakeholders and widely disseminate the necessary explanations, exceptions, and instructions in the clearest language as quickly as possible. This would help avoid a lot of confusion and billing errors that could contribute to misunderstandings about the use of telehealth. Clarification regarding appropriate billing will help inform the research and evaluation plan that was also part of the new policies.

Q: It is clear that telehealth has the potential to address disparities in access to care. Are you at all worried that the sudden transition to permanent menstruation could make disparities worse for some people?

A: Telehealth has brought to light longstanding inequities in the health care system. Some can be resolved by continuing to allow audio-only tours. We’ve seen research that found that older adults and non-native English speakers tended to use audio only rather than live video. That’s why I think it’s important to preserve the audio-only option. But you can’t just use audio for everything. There will be situations where this is not the best way to provide care because live video or in-person care is needed. This is likely to create access differentials for enrollees who may still lack broadband and also have difficulty accessing services in person. So a key question is how can we support access to care for those who face barriers?

More also needs to be done to address digital connectivity so that these patients can experience the benefits of telehealth. That could include expanding broadband access, which other parts of the state government are looking to address. However, this will take time. I hope the state will continue to expand as many options as possible for people to access and receive care, including only audio, until all Californians have sufficient access to broadband and digital devices. or easy access to in-person care.

Q: What do you think should be included in the research and evaluation plan that DHCS will be releasing soon?

A: Clear research and evaluation data will allow DHCS to see how often telehealth is used, how it is used, which patients choose to use it, and where it is used. It will also help identify who is not being helped, where they are and why telehealth is not being used with this population. This would help correlate this data with types of visits and whether racial and ethnic disparities in digital literacy and broadband access are factors.

Understanding the impacts of additional mandates from Medi-Cal-specific providers could also help ensure that disparities between Medi-Cal and commercial patients do not exist. With better education, data, and a better understanding of the use of telehealth, policy adjustments can be made to better serve enrollees and reduce disparities.

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