Teledermatology linked to access to dermatologists for Medicaid enrollees in California

Primary care practices in a large California Medicaid managed care plan offering teledermatology had an increased fraction of patients who visited a dermatologist compared with other practices, according to an article published online by JAMA Dermatology.

Access to dermatologists is limited in the United States due to a shortage of dermatologists and geographic misdistribution. San Joaquin in California's Central Valley has fewer dermatologists per capita than the national average (1.2 vs. 3.6 per 100,000 population). The Health Plan of San Joaquin (HPSJ), a Medicaid managed care plan, began covering teledermatology services in April 2012.

Lori Uscher-Pines, Ph.D., of RAND Corporation, Arlington, Va., and coauthors analyzed claims data to examine whether introducing teledermatology increased the number of Medicaid enrollees who received dermatology care and which patients were most likely to be referred to teledermatology.

The study included 382,801 enrollees from 2012 to 2014. Of those, 8,614 patients (2.2 percent) had one or more visits with a dermatologist and 48.5 percent of the patients who visited a dermatologist received care through teledermatology. Among newly enrolled Medicaid patients, 75.7 percent (1,474 of 1,947) who visited a dermatologist received care through teledermatology, according to the results.

Study results indicate primary care practices that engaged in teledermatology had a 64 percent increase in the fraction of patients visiting a dermatologist compared with 21 percent in other practices.

Teledermatology patients tended to be younger than 17, men and nonwhite. Viral skin lesions and acne were the conditions most likely to be cared for by teledermatology physicians, while in-person dermatologists were more likely to care for psoriasis and skin neoplasms (growths that can be the result of cancer).

The authors note limitations of their study include the generalizability of its results because it describes only the experiences of HPSJ with teledermatology services in California.

"The offering of teledermatology appears to improve access to care among Medicaid enrollees and played an especially important role for newly enrolled patients," the study concludes.