When it comes to paying for new procedures or new ways of delivering care, private insurers often keep their eyes on payment policies from the Centers for Medicare & Medicaid Services. If CMS begins compensation for a service, the private payers will likely follow.
But that rule of thumb may not apply in the new world of reimbursing for telemedicine and telehealth
services. While CMS may have pioneered paying for telemedicine as a way to provide access to those living in rural areas, private payers today are embracing – and reimbursing – a broad range of telemedicine services as a way to squeeze savings out of the current system.
From online video conferencing with a doctor to remote monitoring and alerts to patients with chronic conditions such as heart disease and diabetes, private payers are now leveraging improved technology to better manage the health of their members.
[See also: The year ahead for the ATA, telemedicine.]
“We believe telemedicine can play a critical role in improving health and managing chronic disease, while increasing member satisfaction,” said Ethan Slavin, a spokesman for Aetna. “Telemedicine can also significantly reduce costs by reducing non-medically necessary ER visits and readmissions as members use virtual options for after-hours care and provider instruction.”
Aetna, which first jumped into telemedicine in 2006 via a partnership with RelayHealth, is not alone in its support of these services for its members. Last year, WellPoint announced it would offer online health consultations via a partnership with telemedicine company American Well; Highmark has partnered with Teladoc to provide telehealth service to a broad swath of its members; and recently Cigna announced it would provide online consultations to its members via MDLive.
For payers, providing online health consultations is not merely a bolt-on to existing programs. As MDLive President and CEO Randy Parker told mHIMSS: “What we're doing is taking telehealth into the health plan design, making it a part of the product rather than a stand-alone product.”
Further, where telemedicine initially targeted underserved rural populations, payers have come to understand that it can be a benefit to all members, not just those in underserved areas.
[See also: Telemedicine shows ROI at ATA.]
“Access to primary care is one of the fundamental problems with our healthcare system today, and as we move toward 2014 and a massive expansion of coverage, this problem is going to become a crisis,” said Teladoc CEO Jason Gorevic in an interview on the company’s website. Teladoc helps ease the access issue via its national network of care providers, available to anyone who has signed up for the service.
Unfortunately, while payers have been moving quickly to provide telemedicine services to their members, often with the same out-of-pocket costs as they would incur for an in-person doctor visit, many state insurance and health boards are balking at allowing residents to access care from providers not licensed in their state.
In addition, according to the American Telemedicine Association
, today only 19 states have any kind of mandate requiring private insurers to reimburse for certain telehealth services, with another 10 states considering legislation.
While states drag their feet, it's likely payers who are increasing their coverage of telehealth services may be responding to shifting attitudes among healthcare consumers. According to a recent survey conducted by Cisco Systems
and released in February, 70 percent of consumers are comfortable communicating with doctors via electronic means, versus seeing them in person.
“As we move forward in the telehealth journey, 87 percent said they were willing to give up anything – cost, convenience or travel – to be treated at a perceived leading healthcare provider, to gain access to trusted care and expertise,” said Kathy English, Cisco’s senior director of public sector and healthcare marketing. “So it looks like our patients are craving access to care as a top of mind, regardless of how that happens.”
But as payers are looking to promote telemedicine services to increase access and drive cost savings, some physician groups are wary of the potential to weaken the primary doctor-patient relationship.
“Family physicians should have full discretion in selecting the most appropriate consultants for their patients,” according to the American Academy of Family Physician’s official position on telemedicine licensure and payment. “The technology used to deliver the services should not be the primary consideration; the critical test is whether the service is medically reasonable and necessary.”
But it seems unlikely that payers are looking to transition more care away from a member’s primary care doctor.
“We have always been clear that we do not see telemedicine options as an alternative to the establishment and maintenance of patient care delivered by primary care physicians,” said Slavin. “Rather, we see that telemedicine may complement the patient-physician relationship by making it easier for physicians to deliver care effectively and efficiently, facilitate communication with patients and help improve patient safety.”