Telemedicine for urban uninsured: a pilot framework for specialty care planning for sustainability.

A national approach to medical care for the uninsured is for the provision of primary and preventive care through Community Health Centers. Access to specialty care for both Medicaid and uninsured patients is in decline even though specialty care has been shown to be cost-effective and improve outcomes. The consequences could result in further deterioration of the health of the uninsured and underinsured populations and increasing costs born by the insured and safety net providers. Telemedicine can provide specialty services efficiently if planned with a business model to sustain the program. This paper outlines a pilot framework to plan and cost-justify telemedicine specialty care for the uninsured and marginally insured. This potential framework is supported by data from an urban community with the highest concentration of uninsured in the country: Houston, Texas. Further study and evaluation will be needed once the framework and tools are implemented to empirically prove the sustainability of telemedicine specialty care for the urban uninsured.