New methods for delivering telehealth spur broader reimbursement
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With the telehealth industry now in its second decade, the number of procedures for which payers will reimburse providers is still a very short list – and it isn’t growing quickly.
Private payers tend to follow the lead of the Centers for Medicare & Medicaid Services to provide a roadmap for which services should be reimbursed. Unfortunately for advocates of telehealth and those seeking to improve healthcare access in rural areas, the movement to add new services and CPT codes by CMS is slow and cumbersome – taking a full calendar year for approval.
“At a national level, reimbursement for telehealth services is not where it needs to be,” said Brock Slabach, senior vice president for member services for the Kansas City-based National Rural Health Association. “There needs to be a lot more movement in policy that allows for remote diagnostic and therapeutic services to be provided via telehealth. Once Medicare makes a change then the other commercial payers tend to follow.”
With CMS slowly adding more services to its approved list for telehealth nationally, some states have taken matters into their own hands. Currently, 13 states have laws that require all private payers to reimburse all telehealth services the same as if the service was provided in person in a clinical setting.
In other states, while private payers may look to CMS policies as guidance, they don’t follow them lockstep. The result, according to Mary DeVany, outreach director for the Great Plains Telehealth Resource Assistance Center, is a hodgepodge of coverage for telehealth that varies from state to state, insurer to insurer and even health plan to health plan within single insurance companies.
“For the most part insurers do follow CMS’ lead, but some programs have little twists to their particular coverage,” DeVany said. “For example, in Minnesota Blue Cross Blue Shield covers for telehealth services provided from the home, and that is unique and certainly not included under CMS’ guidelines.”
In addition, she noted, while some insurers may offer limited telehealth benefits, often they are among a suite of features from which employers can choose when designing their plans. So one employer’s workers may have telehealth benefits while employees of the company right next door have none. In short, outside the states that require it by law, insurers don’t include a comprehensive set of telehealth services as a core benefit.
But there are changes afoot in the industry that may push insurers in that direction sooner, rather than later.
Whereas a traditional telehealth consultation typically consists of a patient in a rural area teleconferencing with a doctor perhaps hundreds of miles away at a major medical center, web-based technologies are now making it easier for individuals to receive an online, two-way video consultation from the comfort of their home. What’s more, private payers are lining up to deploy the technology needed to facilitate these online interactions.
One such technology company, four-year-old American Well, has made significant inroads with Blue Cross and Blue Shield plans across the country. Two of its insurer customers, the Hawaii Medical Services Administration and Blue Cross Blue Shield of Minnesota, include online consultations with doctors enabled by American Well’s technology as paid services in its health plans. Still others have deployed the system with doctors in their markets as a convenience for their members, but don’t reimburse for the costs.
One such plan is Blue Cross Blue Shield of Western New York, which launched Online Care in March 2010, aimed at providing its members and the community at large with online medical care via credentialed doctors in its existing care network. It’s a move by the company to be prepared for 2014 when there will be a flood of newly insured people as a result of the Affordable Care Act.
“Essentially we know that access to physicians will only worsen, especially with people who have been either underinsured or uninsured entering the healthcare market,” said Cynthia Eberl, director physician outreach for BCBSWNY. “There will be pent-up demand for primary care doctors and that shortage, that we are already feeling, will get significantly worse. So we see this as a tool where people can have immediate access to a physician.”
Roy Schoenberg, CEO of American Well, sees web-based physician-to-patient care as breaking the mold of traditional telehealth, but also notes that many states are still coming to terms with these services.
“There are always going to be forces working both for and against disruptive innovations. Some states are very careful about introducing telehealth and telemedicine,” Schoenberg said. “Most of them are still suffering from the rules and regulations that were enacted 10 or 15 years ago when online pharmacies came into play that essentially said no healthcare can take place over the web.
“But in the last two years we have seen dramatic changes in the legislation in many different states recognizing that telehealth that connects legitimate licensed physicians with clinically needy patients, does make sense,” he said.
It’s the kind of easy-to-access technology that could be a driving force for getting more telehealth services covered by private payers. Eberl said that, while BCBSWNY does not cover these services, patients are able to use individual health accounts such as HSAs and FSAs to pay. Further, the launch of its Online Care may only be the starting point, as the company has begun to consider covering selected telehealth care in the future, she said.
And that’s a smart move for any insurer, DeVany noted.
“If you have not gotten involved in telehealth you need to, because it is a service that is important and the variety of types of technology and services that will be available is going to blossom in the next several years,” she said. “If you are not at the ground level now, it is going to get overwhelming pretty quickly.”
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