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How North Carolina Implemented Telehealth During COVID-19


Shannon Dowler, M.D., spoke at Academy Health's Datapalooza and National Health Policy Conference on how North Carolina worked with both the local and federal government to expand telehealth in rural and urban areas.

When coronavirus disease 2019 (COVID-19) struck in North Carolina, telehealth was not a viable option right away. Quickly, phases were put into place to add telephone visits and telehealth sessions to insurance.

At Academy Health’s Datapalooza, Shannon Dowler, M.D., chair of the North Carolina Physician Advisory Group, advising DHHS on Clinical Policy for the Medicaid Program, spoke on how the state worked with local and federal government to expand telehealth in both rural and urban areas.

Before COVID-19, North Carolina only had one telehealth program. So, the state got together and began releasing weekly telehealth policies and programs starting in March. Initially it was supposed to be a slow burning process but turned into more than 100 policies and programs by mid-to-late April.

There were six waves which started being rolled out at the beginning of March when there were no cases yet in North Carolina. To get virtual health capabilities in the state, they developed codes for all Medicaid and licensed behavioral providers to pay for telephonic visits. By mid-March they continued developing codes for providers to pay for patient portal communication and for all Medicaid providers to pay for doctor-to-doctor consults. They also developed telehealth capabilities which continued to be rolled out through April, all of which allowed parity payments for all medical, clinical pharmacy, and licensed behavioral providers for all telehealth visits. Telehealth capabilities were further developed in the state and in May, switch determination was developed.

Dowler mentioned the concern that the costs of telehealth would break the Medicaid piggy bank.

With the virtual health and telehealth capabilities in place, there was a huge dip in in-person visits which did not go back up. Still, telephonic care was not reimbursed early on until they decided to reimburse 80% during the stay-at-home order.

Dowler and colleagues studied geography and race when it came to the use of telehealth technologies. They found urban populations were 1.2-times more likely to use telehealth than rural populations, though the gap has become lessened. White patients were 1.2-times more likely to use the technology while non-Hispanic beneficiaries were 1.4-times more likely. Patients with chronic diseases were nearly three-times more likely to use telehealth. Those with access to broadband also used the technology more.

There was a larger percentage of telehealth use for behavioral health rather than physical health from March to December 2020.

Still, providers engaged in teleservices were slower to bill. Some practices suffered from lack of volume and slower billing resulted in more hardship for independent practices. Despite this, primary care practices that adopted telemedicine at higher rates saw a much larger proportion of their patients during the first five months of the Public Health Emergency.

To see how the telehealth and virtual health capabilities were working, Dowler and colleagues released a beneficiary survey, the findings of which demonstrated of respondents whose most recent visit was virtual individual therapy, 59% said they would like to continue virtual therapy if given the option to return to in-person. Black or African American respondents were less likely to want to continue virtual individual therapy (44%) compared to White respondents (73%). And 84% of respondents reported no technical difficulties during their last virtual appointment.

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