How this tech and insurance company are bringing virtual care to Medicaid

The U.S. healthcare system is notoriously varied in terms of access, quality and cost. For Medicaid members, that inconsistency is only magnified.

According to the National Ambulatory Medical Care Survey, physicians are 15% to 20% less likely to accept new patients insured by Medicaid than they are to accept those with Medicare or private insurance. This means Americans with the lowest incomes — and whose health is most likely impacted by factors like food insecurity, housing instability and limited community resources — have trouble finding healthcare providers who will serve them.

But digital care company Galileo and not-for-profit insurer MVP Health Care is making access easier for New York Medicaid members using virtual care. Galileo’s telehealth and care navigation app will enable MVP’s Medicaid enrollees to select a virtual primary care physician, as well as access acute care, specialty care, chronic condition management, pharmacies and labs 24/7 in English and Spanish.

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“If you think about medical care today, it’s highly variable depending on who you’re able to see, the training of your doctor, your insurance coverage and your location,” says Dr. Thomas Lee, founder and CEO of Galileo. “We wanted to level the playing field and design something that offered high-quality care to broader populations.”

While the app itself is a direct-to-consumer benefit, employers and insurance plans can integrate the platform into their offerings. For instance, MVP’s Medicaid members will not be paying out-of-pocket for access to this technology, which may motivate them to seek out preventive care — a key component to keeping healthcare costs down and saving lives.

The Centers for Disease Control and Prevention estimates that if everyone received recommended preventative care, the healthcare system could save 100,000 additional lives per year, and healthcare spending could be lowered by $260 billion. But according to MVP Health Care, nearly 40% of their Medicaid members are skipping primary care visits while still visiting the emergency room and urgent care, alluding to the fact that they are waiting for their health condition to substantially worsen before seeking help.

“Individuals that are on Medicaid are going to have more barriers to access,” says Dr. Lee. “They won’t be able to take as much time off from work to visit a doctor and yet there are fewer doctors who accept Medicaid, so they may have to travel further to get care. In a digital ecosystem, you have instantaneous access to the best cardiologist, the best dermatologist or the best generalist — this is more convenient for the working population.”

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While COVID has pushed healthcare plans to include telehealth services, Medicaid varies depending on state legislation. For example, although every state and Washington D.C. offers Medicaid reimbursement for some form of telehealth, only 22 states include asynchronous telehealth services, which allows for a healthcare provider to evaluate one’s medical information and render a service outside of real-time interactions.

Notably, technology and internet access is still a hindrance for certain populations too, meaning telehealth via app can be a barrier. But only 22 states require Medicaid to reimburse audio-only services, allowing people to access telehealth without an internet connection.

“COVID has changed the lens for a lot of health plans — traditionally healthcare reimbursement was predicated on an office visit,” Dr. Lee says. “The challenge with Medicaid is it requires state action to change and expand, and that’s a constraint for members.”

And while New York does reimburse for asynchronous and live virtual care, Dr. Lee notes that quality is not guaranteed. During his time as a primary care internist, it became obvious how much quality of care varies from plan to plan and even within zip codes. In turn, he wanted Galileo to provide a customized experience to underserved populations, where a team of physicians can provide holistic advice and treatment right from someone's smartphone.

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“Through most of my work, it was quite apparent no matter what practice I was in, that the medical system was getting in the way,” says Dr. Lee. “And there’s a limit to what an individual clinician can do. But a team-based model supported by technology can personalize a patient’s care no matter where they are or their background.”

Dr. Lee believes Galileo’s virtual care model can help eliminate inequity in today’s healthcare system, and they may be on their way. Galileo claims that its users avoid expensive visits to in-person specialty, urgent, or ER care 80% of the time, while 85% of users reported improved health after receiving Galileo care. Galileo’s partnership also goes beyond New York Medicaid members to cover MVP’s employers and those in the Student Health plan across Vermont and New York, totaling 700,000 lives.

“What we're doing is reducing that variability of care and improving the quality and reliability of care for everybody,” says Dr. Lee. “We hope populations like the Medicaid population find us and alongside MVP, reset the expectations of what a health plan can do within Medicaid.”