Cost Analysis of Telehealth Delivery to Children with Diabetes Mellitus Receiving Medicaid Benefits in North Carolina

BACKGROUND The financial viability of telehealth versus in-person visits is still being evaluated post-pandemic. This study used data-driven analysis to determine outcomes of telehealth in a pediatric population with diabetes, assessing financial sustainability as a health care delivery option under North Carolina’s new Medicaid managed care system. METHODS A cost-consequence analysis (CCA) compared costs and outcomes between telehealth and in-clinic care at a hospital-based outpatient pediatric endocrinology practice between July 1, 2021, and June 30, 2022. RESULTS Of 1045 Medicaid claims, the reimbursement rate was above 98% for both telehealth and in-person care. Work relative value units (wRVUs) were higher for in-clinic claims than telehealth, with an average of 2.71 (n = 935, SD = 0.370, 95% CI 2.683–2.731) over 1.81 (n = 80, SD = 0.561, 95% CI 1.695–1.920). “No-show” rates were significantly lower per month for telehealth (9.75, CI = 8.728–10.772) versus in-clinic visits (48.66, CI = 48.137–49.167). LIMITATIONS A cost-consequence analysis is a quick financial tool that compares costs to health and non-health outcomes. Using this methodology, all relevant factors may not be included that could impact outcomes (patient complexity, health status). CONCLUSIONS In this population of pediatric patients with diabetes who utilize Medicaid in North Carolina, there was a high reimbursement rate for both telehealth and in-person care, with no difference between 5 different health plans. Utilizing telehealth minimized no-show rates and potential revenue loss. Care teams should develop stronger telehealth programs facilitating patient engagement. This data has potential to be generalizable to other chronic conditions for pediatric patients under the North Carolina Medicaid system.

Duke Scholars

Author Brigit Maria Carter School of Nursing