Telehealth Engages Rural Iowa Medicaid Population

Thursday, July 16th, 2009
This post was written by Melanie Matthews

“The biggest lesson that we learned was that a Medicaid population can be engaged,” says Dr. Thomas Kline, medical director at the Iowa Medicaid Enterprise, which used telephonic self-reporting to engage Medicaid patients in rural areas of the state in disease and care management programs. “Had you asked me this question before we launched, I would have said, ‘They can’t be reached. You can’t get them involved, and they don’t want to participate.’ But we learned through the development of this program and with the aid and assistance of Pharos [telehealth vendor] that we’re able to identify and engage a much greater percentage of the patient population.

As a result of this increased engagement, the Iowa Medicaid Enterprise is much more effective overall, says Dr. Kline, noting that specific results depended upon participant need.

“Participant “pools” are not always equal. We stratify them into three different areas. The first area is made up of those with more immediate needs and those that were more critical, more beneficial of the intervention care that we provided. The second group is less so and the third group, where we didn’t recruit that many people from that area, is certainly different. Our effectiveness and management was different in all three pools.”

Most importantly, the technology and intervention must be simple, convenient and familiar, stresses Dr. Kline. “This is probably more true in the Medicaid population than it would be for a commercial population. The need is there, but the need for something simplistic, something that can be done and participated in regularly — that if they had access to a telephone, they’re able to push the numbers one, two, three or four — they were simple questions that were kept to a minimum. As a result of the simplicity, more effectiveness occurred.”

Because depression is very prevalent in this population, the program had to address this issue, Dr. Kline concluded. “Because of our success and our experience with this program, we have now incorporated it into all of our programs. To date, we have probably screened in excess of 2,000 Medicaid members, referred approximately 200 of them and we’re engaged with our behavioral health provider. Iowa’s Medicaid experience was successful and beneficial; we plan on pursuing it and keeping it going forward.”

Read more about using health IT in care management to improve health and effect behavior change.

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