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Insurers need flexibility in benefit design to continue telehealth past the public health emergency

CMS Administrator Seema Verma: The Centers for Medicare and Medicaid Services needs help from Congress to make temporary flexibilities permanent.

Susan Morse, Managing Editor

Policymakers must allow for flexibility in benefit design for insurers to continue covering telehealth after the public health emergency ends, according to America's Health Insurance Plans.

Regulatory barriers to telehealth access include restrictions around geography, originating sites and state licensure requirements.

Also, telehealth visits should be clinically compared to in-person care and therefore be counted towards network adequacy requirements, risk adjustment calculations and quality measurement, AHIP said.

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On Thursday morning, speaking before a Health IT Roundtable initiative, Centers for Medicare and Medicaid Services Administrator Seema Verma said CMS is doing everything it can to maintain telehealth in the system. 

The Trump Administration supports its use, she said.

"We do need some help from Congress on this," Verma said, citing a Senate Health Committee hearing in June, "Telehealth: Lessons from the COVID-19 Pandemic." 

At the hearing, Committee Chairman Lamar Alexander said the federal government should permanently extend policy changes that allow physicians to be reimbursed for a telehealth appointment wherever the patient is located, including the patient's home, and permanently extend the policy change that nearly doubled the number of telehealth services that could be reimbursed by Medicare. 

Another 29 other temporary federal policy changes could also be considered to be made permanent, Alexander said. 

WHY THIS MATTERS

Insurers need flexibility in reimbursement to design offerings members want, AHIP said, and consumers have spoken clearly that they want telehealth.

Telehealth use has exploded during the COVID-19 crisis, since restrictions on its use have been lifted during the COVID-19 public health emergency, and patients are staying socially isolated at home.

Akin Demehin, director of policy for the American Hospital Association, said that the regulatory relief has been helping hospitals.

Especially important is parity in reimbursement between an in-person visit and one done virtually.

To work, policy barriers need to be removed, telehealth visits should be aligned to HIPAA standards and organizations must have the technical infrastructure, according to Justine Handelman, senior vice president for the office of policy and representation for the Blue Cross Blue Shield Association.

Handelman spoke during the Health IT Roundtable, made up of 13 organizations of providers, payers and others.

THE LARGER TREND

There's been a 64.3% growth in demand for telehealth in 2020, according to CivicScience research released by AHIP. The demand has grown across all ages and demographics.

CVS Health has realized a 600% growth through MinuteClinic virtual visits and telehealth in the first quarter of 2020; and BCBS of Tennessee has seen 50 times more telehealth visits in May compared to the former average amount.

On June 3, Blue Cross of Idaho announced it had processed more than 90,500 telehealth claims since expanding access on March 19. Between April 6-19, the company processed approximately 10,718 telehealth claims – 118 times more than the weekly average for the first three months of the year. 

ON THE RECORD

"There is a unified call to advance its use," said Justine Handleman of the BCBS Association.

Twitter: @SusanJMorse
Email the writer: susan.morse@himssmedia.com