With patients’ health care in crisis during the COVID-19 pandemic, California took action to make it easier to connect with providers by video, phone, and through online apps. Now telehealth is an essential part of health care, one we trust to connect to providers, behavioral health resources and more without worrying about taking time off workor traveling long distances to receive care.
Yet even as Governor Newsom’s administration is working to help Californians access care more easily through technology, it is preventing providers from connecting virtually to better meet the needs of Medi-Cal patients. Gavin Newsom’s veto of SB 365 means doctors serving people insured under Medi-Cal won’t be reimbursed if they consult with a specialist online or over the phone to provide their patients better care, a practice known as an e-consult. The veto reinforces an already existing divide in health care. Medi-Cal enrollees will continue to face long waits for appointments for specialists, while patients with private insurance can benefit from having their family doctor review tests or images with the specialist, without an additional appointment requiring them to take time off work or find child care.
When a parent brings their child to an emergency room in one of the many rural parts of our state, their ER physician can consult with a pediatric specialist via telehealth to help treat the child while waiting for transportation to a larger hospital — but only if the family is privately insured. Since two-thirds of Californians served by the Medi-Cal program are people of color, it’s easy to see how denying Medi-Cal patients access to specialty care through e-consultations as afforded to privately insured patients furthers inequity.
Opposition to SB 365 by Newsom’s administration is particularly puzzling because connecting primary care providers and specialists has been championed by insurers, health providers, and patient advocates who — over the past six years — have banded together to form a coalition called the E-Consult Workgroup to bring this model of care to more Californians.
Senators representing California’s diverse regions — Anna Caballero (D), representing the Central Valley, Scott Wiener (D) of San Francisco, and Brian Dahle (R) of northern, rural California — championed SB 365. The bill had unanimous, bipartisan support in each committee and floor vote it faced.
California still has an opportunity to harness the benefits of e-consult in the Medi-Cal program including cost-effective access to specialty care for our underserved, safety-net patients and addressing the gap resulting from a shortage of specialty care providers.
Authorizing providers to use e-consult would also go a long way toward meeting the Newsom Administration’s own policy goals, including delivering care to Californians who are homeless and at risk of homelessness with complex chronic conditions, and expanding health care access to Californians, especially Latinos, who speak languages other than English.
Through legislation, budget actions, or administrative decisions, the Department of Health Care Services can allow providers, including community clinics, to bill for consulting with specialists virtually and support family physician practices in gaining access to technology to share patient information safely.
To create a truly equitable health care system in California, one that prioritizes patient health regardless of insurance status, Governor Newsom and the Department of Health Care Services should act immediately to ensure all Californians have access to the expertise of health providers, regardless of where they are.
Greg Buchert, MD, MPH serves as the CEO of GSB Health Management Solutions and a partner at MEDA Angels. He previously served as the President and CEO of Blue Shield of California Promise Health Plan.