At its October 23 meeting, the Joint Commission on Health Care released results and recommendations from an extensive staff study on improving access to care for vulnerable populations. As defined in the study, vulnerable populations “have a high risk for health care problems, face significant hardship, or have a limited ability to understand or communicate effectively.” The report focuses on strategies that extend access to care to vulnerable populations, including older adults, individuals living in rural communities, and individuals who are members of racial and ethnic minority groups, who are also frequently underserved, defined in the report as “systematically denied opportunities to fully participate in health care based on shared characteristics,” such as living in rural areas or living in poverty.
The study examined five strategies to enhance access to care: mobile health clinics, community paramedicine programs, voluntary home visiting programs, community health workers, and telehealth, and offered a series of policy options for Commission consideration at its next meeting, which is scheduled for November 26. Public comments were due November 1. VACo submitted comments on several strategies considered in the report that address long-standing VACo legislative positions in support of voluntary home visiting programs and telehealth.
Key findings and recommendations from the report’s five areas of study include:
Mobile health clinics: These services are provided through specially modified vehicles and can operate flexibly to bring services to patients in areas that may otherwise lack access. This model of care can reduce overall health care costs by avoiding more expensive interventions, such as emergency department visits and hospitalizations. However, logistical and staffing challenges, and inconsistent funding, pose difficulties for the sustained operations of these services. Staff proposed establishing a grant program to support mobile health clinics providing services in rural and underserved areas. Staff also recommended including broadband access for mobile health clinics as a priority for Virginia’s allocation of federal Broadband Equity, Access, and Deployment Program funding, to enhance the availability of telehealth at mobile clinics. Staff also proposed directing the Board of Pharmacy to work with the Department of Behavioral Health and Developmental Services (DBHDS) to allow dispensing of opioid use disorder treatment medications from mobile units (DBHDS is in the process of amended its licensure regulations to reflect certain new federal flexibility, as reported in previous editions of County Connections).
Community paramedicine: These programs involve paramedic-level Emergency Medical Services providers to increase access to primary care, link patients to services, and reduce inappropriate use of emergency resources; programs may schedule home visits with patients who are frequent users of 911 services or respond to low-acuity 911 calls. These programs are provided in addition to traditional EMS responsibilities, and reimbursement from commercial insurance and Medicaid does not fit well with this model of care, as typically EMS agencies are able to bill for services only when patients are transported to the emergency department. Policy options presented in the report include providing grant support to EMS agencies for community paramedicine programs; amending Virginia’s Medicaid program to cover treatment provided by EMS on-scene, without requiring transportation to an emergency department; and requiring the Department of Medical Assistance Services to develop a plan for Medicaid reimbursement of community paramedicine services. Staff also proposed participating in the Ground Emergency Medical Transportation (GEMT) program to provide supplemental Medicaid payments to EMS agencies for emergency transportation services.
Home visiting: These programs assist expectant and new parents and children who are at risk for poor outcomes by connecting the family to a trained professional who offers coaching and other supports. Eight home visiting models operate in Virginia, serving 120 localities, but are only able to meet 5 percent of the need for services in most localities. Home visiting programs are funded by a mix of federal (53 percent), local (25 percent), state (3 percent), and private dollars (19 percent). Staff recommended providing funding to Families Forward Virginia to support required data collection to enable the program to qualify for federal funding; staff also recommended revisiting previous efforts to develop a home visiting benefit through Medicaid.
Community Health Workers: Community Health Workers are trusted messengers who provide a variety of services, including assistance with chronic disease management, public health outreach, and facilitation of access to resources and services. Recent infusions of federal funding have supported Community Health Workers in local health districts, but these funds are time-limited; state funding provided in the 2024 Appropriation Act did not fully cover the amount requested by the Virginia Department of Health for these positions. Staff recommended providing the additional funding to VDH and removing current language requiring VDH to prioritize these positions in areas with high maternal mortality. An additional policy option would direct DMAS to convene a stakeholder workgroup to develop a plan for Medicaid reimbursement for services provided by Certified Community Health Workers (a credential established by the Virginia Department of Health).
Telehealth: The report notes that Virginia has taken several steps to expand access to telehealth, including requiring parity in commercial insurance coverage for services provided via telehealth and in person, and covering an array of services provided through telehealth in Medicaid. The report points out that telehealth can improve access to care by reducing transportation-related barriers, and recommends several proposals to further enhance its use. Staff proposed improving state support of telehealth initiatives at VDH; funding a pilot program of telehealth access points within pharmacies; requiring school boards to facilitate student access to telehealth; providing additional funding to the Virginia Telemental Health Initiative to expand access to mental health care as well as professional development for providers in training; and requiring access to telehealth for individuals incarcerated in jails and prisons.
The full report provided to the Commission is available at this link, and the staff presentation is available at this link.
VACo Contact: Katie Boyle