Push to Expand Telemedicine Parity Continues

Telemedicine got a big boost during the COVID-19 pandemic, and now a number of states have been moving to ensure that health plan enrollees still have access to it and pay for it just as they would in-person visits.

During the pandemic, insurers agreed to pay for virtual visits just as they would for a face-to-face appointment, doctors who had been reluctant to try new technology embraced it as a way to limit patient exposure, and lawmakers loosened federal regulations that for years had restricted telemedicine’s use.

But more than two years into a public health emergency, some health insurers have begun to roll back their pandemic-era coverage policies or fallen into a pattern of extending coverage for only a few months at a time. There are now efforts in a number of states to require that health insurers cover telemedicine visits the same as face-to-face ones.

Thirty-one states mandate both coverage parity and payment parity. The language of the payment parity mandates differs by state. In eight of them, the mandated payment applies only to the deductibles, copayments and coinsurance faced by the insured. For example, in Texas, coinsurance, copayments and deductibles for telemedicine “may not exceed” those for the same service provided in person.

Other states mandate parity in how insurance plans reimburse providers. For example, in Arkansas and California, reimbursement for health care services provided via telemedicine must be “on the same basis as in-person services.”

Telemedicine improves outcomes, saves money

Recent studies have shown that telemedicine can yield significant savings for group health plans and covered employees — but only if the employees actually use it.

The main thrust of telemedicine is to give workers the option to talk to a health care provider over the phone or by video link about a health issue they may be having. Maybe waiting for an appointment slot to open with their doctor would take too long, or perhaps driving to the doctor’s office may be unfeasible for whatever reason.  

Experts say that allowing health plans to charge for telemedicine visits the same as they do for in-person visits can reduce the likelihood that an illness is left untreated, which increases treatment costs in the end, especially if they have to go to the emergency room for treatment.

Telemedicine benefits

Convenience — For many people it’s hard to take time out of the day to go to the doctor, particularly in areas where access to care is limited. For non-serious cases, telemedicine is a good option. If the physician or nurse feels that symptoms are serious, they can always ask the covered individual to come in for an appointment.

Cost savings — Just by its nature, telemedicine can save money, particularly for individuals who habitually go to ER or urgent care for routine services. Telemedicine can be marketed to employees as a much less expensive alternative for after-hours care.

Managing chronic illness — Telemedicine is ideal for workers with chronic conditions who may have a hard time getting to regular doctors’ appointments. Technology exists that can transmit health data from a patient’s home to a doctor’s office.

Addressing concerns

Many people are uneasy about working with a provider over a video link if they have had no prior patient relationship with them.

You can address these concerns by:

  • Highlighting credentials of doctors in the telemedicine network.
  • Working with us or your health insurer to try to change plan designs in order to eliminate copays for telemedicine.
  • Setting aside a room at your offices where your staff can access telehealth services, particularly if they have chronic conditions that may need monitoring on a regular basis.
  • Choosing the right vendor, which is crucial. Evaluate vendors based on patient satisfaction, the quality of the providers and the breadth of specialties available.

Telemedicine Taking Off, Reducing Health Costs

One of the fastest growing parts of the health care system, and which touches significantly on group health plans, is telemedicine.

From 2016 to 2017, insurance claims for services rendered via telehealth as a percentage of all medical claim lines ― grew 53% nationally, faster than any other avenue of care, according to “FH Health Indicators,” a white paper published by the nonprofit FAIR Health.

Telehealth uses technology to provide remote care via video conferencing and other means and is proving to be more and more effective, especially for time-pressed individuals or people who live in rural areas where patients often have to travel great distances for care.

Elderly patients especially find it useful, since it eliminates the need for transportation.

But as telehealth gains traction, the focus is shifting away from the novelty of connected devices and new technology and more toward providing patients with top-notch care ― and giving providers, physicians and nurses alike the power to deliver it effectively. As it evolves, it is also a promising new trend in terms of reducing health care delivery costs.

Telehealth can reduce the cost of care by eliminating the physical barriers that prevent patients from managing their health. As more patients take advantage of digital services like remote patient monitoring, automatic appointment reminders, and remote physician consulting using live video and audio, patients can use these services to reduce the cost of care and improve their chances of early detection.

And that can reduce your overall group health plan costs, as well as out-of-pocket costs for your employees.

Tech firms are coming up with more efficient ways for patients to communicate with their doctors that save time and money, and reduce liability for doctors as well. For example, more and more health care practitioners are adopting an online patient portal as a direct link between the patient and the doctor.

Doctors, patients embrace online portals

The portal can easily be password-protected for each patient and streamline routine interactions from appointment-setting to refilling prescriptions ― and everything in between. 

For example, when it’s time to get a prescription refilled, the patient simply makes a request to his or her doctor, via the patient portal or even via a cell phone or tablet app that can be proprietary to the practice. The doctor checks the dosage and approves the request in a few clicks, and in seconds the information is sent directly to a pharmacy so the patient can pick up the prescription.

The patient doesn’t have to get the doctor on the phone or bug the staff for a moment with the doctor, and the doctor doesn’t have to do additional paperwork or get on the phone with the pharmacy to call in the prescription after already having spoken with the patient on a separate call. The result is tremendous time savings ― and ultimately, cost savings for both the doctor and patient.

Online portals also facilitate communication between doctors and patients between appointments. If a patient has a question or clarification that does not warrant an additional office visit, the doctor or staff can quickly respond in an instant, without playing phone tag, and without having to route calls to busy doctors who can’t always be on the phone.

Physicians can also leverage these portal technologies to send lab results and images directly to the patient using a secured and encrypted link, and to make clinical summaries easily available online. When the doctor adds new information to the file, such as a lab report, the portal system can be programmed to automatically send an e-mail alert to prompt the patient to log onto the portal.

For all the technology though, we still have a way to go in implementing it. According to a recent study in the Journal of General Internal Medicine57% of respondents said they want to use their doctor’s website to review their medical records, but only 7% of those polled reported having made use of that technology to access their own information online.

A study from the Annals of Internal Medicine found that 77% to 87% of individuals who used their physician’s portal to open at least one note, and who completed a post-intervention survey, said that the process helped them be more in control of their health care.