You and the boom in telehealth (online exclusive)

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Doctor, cell phone

You and the boom in telehealth (online exclusive)

By Alexander Gore and John Knutila, The Value Builders

The only constant is change. That was true for telehealth as it gained shape and use for years. Then the pandemic supercharged the changes. The CARES Act loosened rules and regulations for who could receive, provide, and bill for telehealth services.1 In turn, demand and supply grew. In one February 2021 estimate, the use of telehealth was 38 times higher than before the pandemic, with 40 percent of consumers reporting they would continue using remote services.2

Many telehealth policies expanded during the pandemic have been extended through December 31, 2024.3 Beyond that, policymakers will need to make hard decisions or continue with temporary extensions.4 Either way, a range of changes in telehealth are coming and will impact reimbursement policies, technology infrastructure, privacy, provider and patient/member adoption, and economic factors. We’ll explore several implications of those changes (as well as provide access to information tools).

Telehealth is a term used to describe comprehensive healthcare services delivered remotely using some form of information-communication technology. Services may include clinical care, patient education, administration, and provider training.5 These remote services are generally organized in four application categories6:

  • Synchronous: live interaction between patient and provider
  • Asynchronous: communication and information shared in different points in time (i.e., lab results)
  • Remote patient monitoring (RPM): transmission of data electronically (i.e., blood pressure monitor)
  • Mobile health (mHealth): for example, use of mobile phone or fitness tracker

Let’s look at what current and future telehealth means for you as provider, patient/plan member, or payer.

Providers: the keystone in the adoption of telehealth

Based on a survey of physicians primarily serving Medicare patients, up to 25 percent of the total cost of care by 2025 could shift to telehealth (up to $265 billion), without reducing quality or access.2 CMS supports telehealth utilization through 2024 by maintaining the waiver of geographic and originating site restrictions (such as rural providers and patients).3  

The AMA supports expanding coverage of telehealth services and making pandemic-related flexibilities permanent.3 Those flexibilities include loosening privacy regulations, allowing phone visits to qualify as telemedicine, allowing clinicians to practice across state lines, and waiving the need for a pre-existing relationship.7 The Department of Health and Human Services provides a list of Best practice guides to help private practitioners, hospitalists, and administrators use telehealth to connect with patients.

Behavior health saw a particularly large rise in telehealth utilization during the pandemic, from 32 percent pre-pandemic to 60 percent of visits in Q1 2022. This trend is expected to continue as the expansion of approved behavior health providers and provider networks grows.8

Patients: convenience and more (i.e., home delivery of medicine)

Telehealth may be a step forward for patients and member care, but in a way it’s also a step back — to the days when doctors made house calls. Call it digitally driven house calls. Beyond the convenience of receiving health services at home, patients/plan members can benefit from potentially reducing preventable health events and lower-cost site of care.2 Patient services currently in place include primary, outpatient-specialist, urgent, and hospice care; care in place but needing more extensive capabilities include post-acute/long-term care, infusions, dialysis, and acute care.2

And regarding convenience, on January 4, 2024, Eli Lilly announced a new telehealth service that supports the goal of simplifying the patient experience of those living with obesity, migraines, and diabetes.9 LillyDirect includes a digital pharmacy with free home delivery, disease state and healthcare education, and access to independent telehealth providers as an addition to current primary care team or as alternative for some therapeutic areas. Lilly calls it an end-to-end experience for people to manage their health and access their medicines.9 It will be interesting to track the performance of this offering and whether other companies launch similar services in the months and years ahead.

Payers: providing critical access to, and reimbursement for, telehealth

As cited above, Medicare is expanding or extending coverage in many telehealth services. Medicaid is following suit, although policies differ by state. Commercial payers also differ in telehealth coverage. The National Telehealth Policy Resource Center provides a Fall 2023 Summary Chart of state Medicaid reimbursement for telehealth applications (i.e., live, store-and-forward, RPM, and mHealth). Included are laws by state for private payer telehealth parity payment.10

Telehealth regulation differs by type of commercial health plan: self-insured plans are regulated by the federal government; fully insured plans must comply with both federal and state requirements. Private insurers are free to decide which telehealth services to cover.7  

Reimbursement policies, such as payment parity for telehealth or value-based payment, are a critical variable in the adoption of remote care.7 CMS offers Telehealth Services fact sheet with an overview of existing and new covered telehealth services, and a detailed List of Telehealth Services with HCPCS  codes.

AHIP is on board, citing the benefits of delivering high-quality care through a convenient medium for improving care outcomes, and reducing costly emergency department visits and ensuring that patients get the right care at the right time in the right setting.11

AI and digital determinants of health

The newest healthcare stakeholder — artificial intelligence — is quickly asserting itself in telehealth, with the goal of overcoming barriers to quality care such as time and location constraints. Beyond commonly voiced hopes and fears about using AI are the same digital needs across our culture  — expanding digital literacy, access to technology, and infrastructure access to WiFi and broadband.12 These will need to be addressed as AI is naturally linked positively or negatively to health equity. AI and digital technology in general must overcome disparities and find new ways to benefit more stakeholders as telehealth expands.

Summary

As more providers, patients, payers, and policymakers agree on the framework and benefits of telehealth, the “tele” may eventually disappear in a unified system of healthcare delivery — telehealth as a popular addition to, rather than replacement of, in-person care.13 It won’t happen in 2024, but various decisions in service, product delivery, and reimbursement are moving the industry in that direction — as you in whatever your role is will likely experience.

References

  1. American Medical Association. CARES Act: AMA COVID-19 pandemic telehealth fact sheet. Accessed January 10, 2024. 
  2. Bestsennyy O, Chmielewski M, Koffel A, Shah A. McKinsey & Company Healthcare. From facility to home: how healthcare could shift by 2025. Accessed January 6, 2024. 
  3. American Medical Association. How telehealth’s future came into clearer view in 2023. Accessed January 8, 2024. 
  4. Center for Connected Health Policy. New year: what’s the policy now? Accessed January 8, 2024. 
  5. Shaver J. The state of telehealth before and after the COVID-19 pandemic. Prim Care Clin Office Pract. 2022;49(4):517–530.
  6. Department of Health and Human Services. Getting started with telehealth. Accessed January 8, 2024. 
  7. Weigel G, Ramaswamy A, Sobel L, et al. Opportunities and barriers for telemedicine in the U.S. during the COVID-19 emergency and beyond. KFF Women’s Health Policy. Accessed January 11, 2024. 
  8. PwC Health Research Institute. Medical cost trend: behind the numbers 2024. Accessed January 6, 2024. 
  9. Eli Lilly and Company. Lilly Launches End-to-End Digital Healthcare Experience through LillyDirect. Accessed January 10, 2024. https://investor.lilly.com/node/50106/pdf
  10. Center for Connected Health Policy. State telehealth laws and reimbursement policies. Accessed January 8, 2024. 
  11. AHIP. Telehealth. Accessed January 9, 2024. https://www.ahip.org/issues/telehealth
  12. Andrikopoulou E. Emerging Practices in Telehealth: best practices in a rapidly changing field. Accessed January 6, 2024. 
  13. National Telehealth Resource Center. A framework for defining telehealth. Accessed January 8, 2024. 
Alexander Gore, The Value Builders, The Bloc Alexander Gore is VP, creative director of The Value Builders. Gore has more than 11 years of managed markets experience across multiple therapeutic areas. At The Bloc, he leads The Value Builders copy department. As a market access creative he has generated and overseen award-winning pre- and post-launch initiatives that range from preapproval information exchange materials and payer value propositions to standalone branded access and reimbursement hubs.
John Knutila, The Value Builders, The Bloc John Knutila, VP Creative Director for The Value Builders, has 20 years experience writing strategically-grounded, educational, and promotional content for market access, professional, and patient/consumer audiences, translating evidence-based clinical and economic content into clear, compelling copy across media.