# The role of telehealth in improving access to and costs of unscheduled care among lower-income individuals

> **NIH AHRQ R01** · NORTHWESTERN UNIVERSITY · 2024 · $394,577

## Abstract

PROJECT ABSTRACT
Immediate (or “urgent”) care treats injuries or illnesses that lie between primary and emergency care. During the
COVID-19 pandemic, virtual immediate care made up the largest share of visits in the new, expanded telehealth
infrastructure. The rise of virtual immediate care has important implications for health care access and costs,
especially among those with Medicaid. Access to and costs associated with immediate care are especially
important considerations for this marginalized group, who are less likely to engage in primary care, rely more
heavily on expensive emergency department care for non-urgent conditions, and use more immediate care than
those with higher incomes. Though virtual care is widely thought to increase care access and reduce costs, there
are well-documented reasons to believe that these benefits might be offset among Medicaid enrollees. For
example, those with lower incomes are less likely to have broadband access, rendering virtual care largely
inaccessible. When it comes to spending, shifting urgent care visits away from the emergency department
represents an important cost-savings opportunity. However, telehealth visits may also increase costs, by acting
as a complement to in-person care, rather than a substitute, and by inducing new demand that otherwise would
not have occurred. Further complicating the picture, the impact of virtual immediate care on access and costs
likely differs across different types of telehealth models, and across different marginalized subpopulation (e.g.,
those living in rural areas, racial and ethnic minority groups, individuals with special health care needs, and
women). To date, no study has measured the impact of virtual immediate care among Medicaid enrollees. Yet,
as the public health emergency draws to a close in May 2023, state Medicaid agencies face important decisions
on whether to permanently extend COVID-era telehealth policies. Our study’s purpose is to generate urgently-
needed evidence to inform the policy conversation regarding telehealth and Medicaid, curating results that will
be immediately useful to policy-makers. Using a mixed-methods approach, we will conduct quantitative analyses
using extensive health record data from major health care systems across three states, followed by stakeholder
interviews with both Medicaid administrators and health systems leaders. Our aims are 1) Measure the impact
of different telehealth delivery models on immediate care access and use among low-income individuals, overall
and by subpopulations; 2) Calculate the impact of different virtual immediate care delivery models on health care
episode costs, accounting for downstream care and new health care use that would not have otherwise occurred,
overall and by subpopulations; 3) Conduct semi-structured interviews with Medicaid administrators and health
system leaders to transform study results into practicable knowledge for policymakers.

## Key facts

- **NIH application ID:** 10932315
- **Project number:** 5R01HS029340-02
- **Recipient organization:** NORTHWESTERN UNIVERSITY
- **Principal Investigator:** Lindsay Allen
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** AHRQ
- **Fiscal year:** 2024
- **Award amount:** $394,577
- **Award type:** 5
- **Project period:** 2023-09-30 → 2027-07-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10932315

## Citation

> US National Institutes of Health, RePORTER application 10932315, The role of telehealth in improving access to and costs of unscheduled care among lower-income individuals (5R01HS029340-02). Retrieved via AI Analytics 2026-05-25 from https://api.ai-analytics.org/grant/nih/10932315. Licensed CC0.

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