Teledermatology Improved Dermatology Access For New Medicaid Patients Interview with:

Lori Uscher-Pines, PhD RAND Corporation Arlington, Virginia

Dr. Uscher-Pines

Lori Uscher-Pines, PhD
RAND Corporation
Arlington, Virginia What is the background for this study? What are the main findings?
Response: Although many communities in the U.S. are underserved by dermatologists, access is particularly limited among Medicaid patients. Teledermatology may be one solution to improve access. Our goal with this study was to assess the effect of a novel teledermatology initiative on access to dermatologists among enrollees in a Medicaid Managed Care Plan in California’s Central Valley.

Among all patients who visited a dermatologist after the introduction of teledermatology from 2012-2014 (n=8614), 49% received care via teledermatology. Among patients newly enrolled in Medicaid following Medicaid expansion in 2014, 76% of those who visited a dermatologist received care via teledermatology. Patients of primary care practices that engaged in teledermatology had a 64% increase in the fraction of patients visiting a dermatologist (vs. 21% in other practices) (p<.01). Compared with in-person dermatology, teledermatology served more patients under age 17, male patients, nonwhite patients, and patients without comorbid conditions. Conditions managed across settings varied; teledermatology physicians were more likely to care for viral skin lesions and acne whereas in-person dermatologists were more likely to care for psoriasis and skin neoplasms. What should clinicians and patients take away from your report?

Response: The offering of teledermatology appears to improve access to care among Medicaid enrollees and played an especially important role for newly enrolled patients. The novel model of telehealth offered in this health plan incorporated by consultative and direct care elements, and teledermatologists were available for in-person follow-up with patients that could not be managed virtually. This particular model, and teledermatology in general, offer promise for other Medicaid plans that struggle with meeting the specialty care needs of traditional as well as new enrollees. What recommendations do you have for future research as a result of this study?

Response: Future research should assess the quality of services provided and the satisfaction of patients and referring health care professionals with this model of teledermatology as compared with others.

The teledermatology literature has demonstrated high rates of diagnostic accuracy, diagnostic concordance, and patient and health care professional satisfaction. However, the effect of teledermatology on access to care at the population level has rarely been assessed. We need additional studies such as this that describe the impact of telehealth initiatives at the population level. Thank you for your contribution to the community.


Uscher-Pines L, Malsberger R, Burgette L, Mulcahy A, Mehrotra A. Effect of Teledermatology on Access to Dermatology Care Among Medicaid Enrollees. JAMA Dermatol. Published online May 04, 2016. doi:10.1001/jamadermatol.2016.0938.

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

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Last Updated on May 5, 2016 by Marie Benz MD FAAD