A new normal for telehealth requires reimbursement and benefit design

Telehealth is the new normal as providers have invested in the technology to make it happen during COVID-19, but how much of its use continues past the pandemic depends on continuing government flexibility and in-person reimbursement levels and what insurers include in their health plans for 2021.

The Association of American Medical Colleges recently sent a letter to Centers for Medicare and Medicaid Services Administrator Seema Verma urging the administration and Congress to make permanent some of the telehealth waivers and flexibilities that were put in place during the COVID-19 public health emergency.

The AAMC, among other recommendations, urges Congress and CMS to make permanent the current changes and ensure that reimbursement remains at a level that will support the infrastructure needed to provide telehealth services.

The American Telemedicine Association (ATA) also sent a letter to Congress outlining additional funding and policy changes needed to address remaining barriers to appropriate virtual care.

A Guidehouse survey of Healthcare Financial Management hospital and health system executives shows that 67{f08ff3a0ad7db12f5b424ba38f473ff67b97b420df338baa81683bbacd458fca} predict their organizations will use telehealth at least five times more than they did pre-pandemic. Removal of regulatory barriers, more lucrative reimbursement models, increased startup funding, and rapid shifts in access have catalyzed telehealth adoption, according to the survey.

Only one-third said their organizations are up to speed on all of the needed telehealth capabilities.

WHY THIS MATTERS

Looking forward, digital strategies, including telehealth and contact centers, are the most often cited tactics executives say their organizations will implement or enhance to grow future revenues, according to Guidehouse, which acquired Navigant in October 2019.

“Through all the uncertainty COVID-19 has presented, one thing hospitals and health systems can be certain of is their business models will not return to what they were pre-pandemic,” said Guidehouse Partner Dr. Chuck Peck, a former health system CEO. “A comprehensive consumer-facing digital strategy built around telehealth will be a requirement for providers.”

During the Advisory Board’s weekly COVID-19 Update, Rachel Sokol, who leads the research team for the Health Plan Advisory Council, said 2021 will be the pivotal year in looking at what health plans offer for telehealth benefits and how provider groups are thinking moving forward, whether they are fully invested or would prefer to return to the in-person model.

“Providers are invested here,” said Christopher Kerns, vice president of Executive Insights.

Health plans may still be looking at the value of telehealth, according to Christopher McFadden, managing director of Healthcare at investment firm KKR.

“Measuring value is a complex exercise,” McFadden said. “There’s a value of consistency in seeing a physician.”

In telehealth, questions remain on whether there is a continuity of care.

But both employers and employees want telehealth. “There is support from large employers who see the value in these services and recognize their employees are interested in them,” McFadden said. “I can’t see the health plans are moving at the same pace. I think large employers are strongly supportive of it. I think health plans are moving at a slightly different pace.”

However, McFadden sees telehealth moving forward.

“I am optimistic because I think it makes good sense,” he said.

Health plans Welltok works with are onboard with telehealth as a cost-effective option that allows the same level of service as an in-office visit.

“They’re seeing this as an opportunity,” said April Gill, senior vice president of Solution Management. “The plans that we’ve been working with are still a little bit in the reactionary stage. Now they’re just starting to get to the second phase of, ‘How do we prepare members for returning to an environment that is a new normal?’ As we come out of this, telehealth and virtual visits will become a new normal. Employers and plans alike are thinking long-term.”

Virtual visits can help manage chronic conditions and with more companies offering work at home strategies, there’s a surge of interest in and the necessity of, general health and well-being also being managed from the home.

There’s been an enormous uptick in the use of telemedicine, but also some confusion of what constitutes a telehealth visit, according to James Brown, CEO of Smart Communications.

“What is covered?” he said. “There needs to be much more clarity for what’s covered by telehealth.”

Prior to COVID-19, Brown said the trend was already towards insurers offering a modernized, more consumer-friendly experience to make member interactions more compelling. Digital health will continue that trend through telehealth, apps and even personal digital assistants such as Siri, Alexa and Google Assistant.

“My sense is that this is one of those areas where the post-pandemic world will have fundamentally changed,” Brown said. “I think we’ll see insurers embracing telemedicine, and it will become part of the new normal. I don’t see us returning to where we were.”

THE LARGER TREND

CMS began the road to greater use of telehealth in April 2019, when it created new flexibility in Medicare Advantage plans.

In March, CMS allowed for flexibility in telehealth under the pandemic, allowing for 80 additional services.

Numerous companies have expanded telehealth.

In early May, Babylon and Mount Sinai Health Partners began offering round-the-clock video consultations for New Yorkers through an AI-powered app.

Premera Blue Cross launched its first virtual-care health plan for member access to primary care providers.

The Federal Communications Commission has been approving COVID-19 Telehealth Program Applications with funds from the Coronavirus Aid, Relief and Economic Security, or CARES Act.

To date, close to $25 million has gone to 56 healthcare providers in 23 states.

ON THE RECORD

“Our nation has come to fully recognize the power of telehealth and we urge Congressional leaders to continue working to ensure patients who benefit from telehealth and other remote technologies do not lose essential access to care,” said Ann Mond Johnson, CEO of the ATA. “The new realities of healthcare delivery in a post-COVID-19 world will necessitate the continued use of telehealth to support social distancing and maximize healthcare resources. Further, the continuation of many temporary policies, and enactment of new, permanent statutory and regulatory changes, will be needed as America returns to ‘normal.'” 

Twitter: @SusanJMorse
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