Conference

Combined Sections Meeting of the American Physical Therapy Association for the Academy of Leadership and Innovation

Document Type

Poster

Date

2-2025

Abstract

There are differences in access and utilization of care for patients with Medicaid. When patients cannot access timely therapeutic care, the resulting outcomes are often poor. Because a major limiting factor in accessing services is insurance type, investigating optimal coverage practices is an important first step in advocating for change. This abstract reports on Phase One of a larger collaboration with state professional associations for physical therapy (PT), occupational therapy (OT), and speech-language pathology (SLP) to present a model that describes Medicaid authorization services for PT, OT, and SLP, serving as a guide for policy change.

We collaborated with the reference librarians at the Academic Health Science Center library, using 29 search terms to find 22 papers. An additional 7 articles from non-indexed journals were discovered. After reviewing the abstracts, we found 14 relevant papers; full texts were available for 12, while 2 were abstracts only. A literature table was created. Team members independently developed themes based on the findings, then jointly discussed, prioritized and defined these themes in relation to the collaborative purpose.

The model is grounded in six themes that emerged from the literature review: 1) Why patients need PT, OT, and/or SLP (utilization), 2) Optimal number of PT visits and access to care, 3) Administrative costs/burden, 4) Disparities in care based on sociodemographic status, 5) Insurance coverage policies and delay of care, and 6) Facilitators/barriers to policy change and advocacy. Visualized as a Venn diagram, the model illustrates the optimal number of PT visits before requiring pre-authorization, overlapping with three key factors: reducing administrative burden, aligning with policy facilitators, and promoting care for all sociodemographic groups.

Our model is a first step for creating an effective tool that will serve as a guide for policy change. With patient-centered policies that recognize all themes of our proposed model, PTs can advocate for timely, accessible care for all patients.

This project includes two areas of clinical relevance: First, the project consists of three phases. Phase One involved creating the model. The next phase will apply the model to actual claims data to analyze patient visits, considering variations in common medical diagnoses and age. The final phase involves sharing the findings with stakeholders to guide policy decisions.

Change is complex and must be data-driven, requiring the investment of stakeholders at multiple levels. Second, this project exemplifies leadership and collaboration between an academic health science center, state professional associations, and a state’s designated Medicaid plan (United Healthcare) to achieve a model based on data to guide optimal decision-making for patient/client access for PT services. This work showcases the integration of clinical perspectives and rigorous research methods to inform change.

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