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Payer Expansion of Telehealth Initiatives

As COVID-19 spurs expansion of payer telehealth offerings, some say initiatives begun during the pandemic could become the norm.

In 2020, the COVID-19 pandemic quickened the adoption of telehealth as many members turned to remote, virtual care services as a way of managing their health while limiting their exposure to the coronavirus. The unusual circumstances have driven acceptance levels—by providers, insurers, and members—in record time. 

“The pandemic single-handedly reignited the health care industry’s interest in telehealth,” said Ricky Garcia, MBA, director of strategy, innovation and population health at Premier, a health care improvement company. In just a handful of months, the industry reached a level of clinical and operational change that could have otherwise taken a decade or more, he told First Report Managed Care.

Federal and state regulatory flexibilities have also played a key role in supporting widespread adoption as policy changes enabled different technologies, clinical staff, and care sites to be used to deliver services. Mr Garcia anticipates that “these flexibilities will be difficult to completely unwind and will largely remain in place post-pandemic, further buoying the long-term market outlook for telehealth.” 

New Year, New Payer Telehealth Initiatives 

In response to evolving preferences and increased consumer demand, some insurers have expanded telehealth initiatives or launched new ones in an effort to provide added flexibility and convenience in 2021.

As the New Year began, so, too, did Kaiser Foundation Health Plan of Washington’s Virtual Plus health care plan. Announced in September, the new plan allows members to reach out by email, online chat, phone, or video for nonurgent issues. Members also have access to pharmacists through an online or video visit as well as medication deliveries. 

Humana Healthy Horizons in Kentucky and Vida Health launched a partnership designed to offer a virtual diabetes management program to the state of Kentucky’s Medicaid population. As of January, the new initiative enables individuals to access Vida’s group diabetes coaching, peer group support, and digital therapeutics for diabetes as well as co-occurring chronic conditions like obesity or hypertension. 

The digital experience is personalized to each user, combining both provider expertise and machine learning algorithms to address the root causes behind diabetes and encourage adoption of long-term behaviors that could alter the course of the disease.

In mid-January, UnitedHealthcare initiated expanded availability of virtual care with local physicians for members enrolled in employer-sponsored plans as well as the introduction of a new virtual primary care service meant to enable access to medical services in an easier, more convenient manner. Eligible members can visit virtually with providers for various forms of care, such as annual wellness visits, appointments for minor ailments, and checkups for ongoing issues such as asthma or high blood pressure.

The new virtual primary care service, designed to make it easier for patients to establish and maintain a relationship with a primary care provider, is available for members enrolled in certain plans in 11 states. According to a CNBC report, the service is offered in collaboration with Boston-based telemedicine company Amwell and is expected to expand to additional states. 

Meanwhile, the Blue Cross and Blue Shield Federal Employee Program revealed newly expanded telemedicine benefits for 2021. In recognition that virtual visits are becoming more than just a temporary solution to the current crisis, a mid-October press release revealed plans to cover virtual services as a regular benefit even after the pandemic ends.

Cost and Quality Implications of Telehealth Trend

Although telehealth use has fallen from its peak in April 2020, when some providers completely closed their doors, the use of telehealth remains high compared to pre-pandemic levels, according to Mr Garcia, who anticipates that it will continue to become a larger aspect of care delivery moving forward.

Many provider organizations are utilizing a range of telehealth technologies to redesign their clinical models and limit investments in brick-and-mortar assets, he pointed out. Typically, their goals are to make care delivery possible in lower-cost sites and to improve upon outcomes by increasing access. 

“From a cost perspective, expect a greater ability to manage lower acuity patients through asset-light telehealth programs, while reserving in-person care for more complex patients,” Mr Garcia said. “From a quality perspective, expect increased provision of care to vulnerable populations, expanded access to specialists, and improved wait times for services.” 

He predicts heightened levels of consumer engagement, too, which should lead to decreased cancellation and no-show rates.

It is important to remember that the industry is currently in a period of heavy innovation and experimentation when it comes to many telehealth technologies, he noted. Some telehealth technologies will not gain traction for various reasons, such as investment requirements, limited consumer uptake, or lack of return on investment. Others, meanwhile, will be integrated into day-to-day care delivery processes over time.  

Will Telehealth Become a Standard of Care?

In recent months, there has been plenty of talk regarding telehealth and wonderings as to whether the types of initiatives started during the pandemic will eventually become a standard of care.

As a whole, industry is waiting to see how quickly the Centers for Medicare & Medicaid Services and other payers alter their telehealth payment parameters when this public health crisis is finished, according to Joe Nicholson, DO, chief medical officer at CareAllies, a CIGNA company. But there are few who debate that it will remain a paid benefit that is bound to continue increasing access to care both this year and beyond.

Practices will need to accept that everything has changed and will need to focus on providing the best care for patients as they possibly can, he explained. To do so, they will need to get creative about when and how to engage patients in order to address their evolving needs. 

While some services will require an in-person visit, plenty of primary care can take place virtually. As a result, Dr Nicholson believes that telemedicine’s ability to extend the reach of care, particularly into underserved communities, does have great value. 

Some telehealth initiatives that emerged due to pressure from the pandemic have improved the health care system, and there is a push from some medical professionals and industry experts to make virtual visits a standard part of care moving forward, explained Gary Call, MD, chief medical officer at HMS, a provider of health care cost containment solutions. 

The increased convenience and access to care appeal to large segments of the population, such as rural residents, seniors, and younger health care consumers. And virtual visits will likely become a more common format for appointments with mental or behavioral health providers in particular considering these visits mainly involve verbal communication—an efficient model for both members and providers. 

It will be crucial to monitor quality outcomes and determine whether they improve or decline as a result of dramatically increased utilization of telehealth visits, he said. It is possible that outcomes will differ for different medical conditions, and this could help in building guardrails for which types of issues are most appropriate for telehealth and which ones may call for in-person visits in order to optimize the health of consumers. 

“When in-person care options return in full force, different sectors of the health care system will likely re-evaluate the role of telehealth to determine its long-term impact and effectiveness,” Dr Call predicted. But with so many consumers stating they intend to continue using telehealth post-pandemic and so many providers planning to continue offering the service as much or more than they currently do, it appears that telehealth is here to stay.

“The momentum for telehealth is significant as regulatory and reimbursement changes become permanent and increased portions of the population gain experience due to the pandemic,” Dr Call added. “More work needs to be done to clarify the impact on health care cost and quality, but it appears that telehealth will continue to take a larger role in the health care landscape.” 

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