More on Reimbursement

Payer telemedicine expansions raise new opportunities

Long heralded by technologists, telemedicine is increasingly in demand from consumers. But as insurers warm to reimbursing the service, challenges loom in attaining healthy return on investments.

According to estimates from Deloitte, almost one in six primary care consultations will be digital this year, driven in part by consumer demand for convenience in seeking non-emergent care and in part by improving, more affordable internet-based video conferencing technology.

Numerous telemedicine startups have launched in the past few years -- Ringadoc, Doctor on Demand, Sherpaa, among others -- and coverage of the service has been a way for insurers to boost their innovation credibility.

The New York City-based startup insurer Oscar Health has garnered quite a bit of attention thanks in large part to its coverage of telehealth, including free phone calls with docs. Established insurers have been gradually offering coverage, too, some going back years.

Aetna has covered telemedicine in some markets for the better part of a decade; early this year Cigna started offering telemedicine to self-insured clients through a partnership with MDLive; and now WellPoint is in the midst of a year-long roll out of an e-visit service for many of its Anthem Blue Cross members -- via its own telemedicine subsidiary, LiveHealth Online.

Various models

The models insurers are using vary, from offering a third party service with staffed physicians on-call to facilitating e-visits with members' local in-network providers to hybrids currently under experimentation. Some bring unique benefits and others may pose hazards, in terms of meeting customer expectations.

WellPoint's LiveHealth Online is a 24/7, 365 telemedicine service staffed by a national network of independent physicians, available to anyone for $49 per online visit and set to be available to many commercially-insured Anthem members in 10 states by the end of the year, for just about $20 or the cost of a primary care co-pay.

The service is largely targeting the urgent care problem -- late night coughs or an odd rash on your toddler. It's pitched to members and customers as "an option when their regular physician is not available, not as a replacement for the relationship they have with their regular physician," said WellPoint communications director Lori McLaughlin.

WellPoint is also piloting a project to offer telemedicine service as a connector for network providers, so physicians could make themselves available to Anthem members by appointment or at certain times, if not 24/7. "Perhaps something like that would be available in the future," McLaughlin said.

Other insurers are using that model as the foundation of their telemedicine strategy -- to make the technology available to network providers and let them figure when and out to digitally care for members.

Arches Health Plan, Utah's consumer-oriented and operated insurer, is in the midst of bringing telemedicine technology to its 4,500-physician network through a partnership with the Salt Lake City-based company TruClinic. The insurer is making the telemedicine available to providers -- and then leaving it up to them to use it however they prefer.

"We wanted a solution that our own network could utilize so our members could use this technology with their own providers," said Tricia McGarry-Schumann, Arches chief marketing officer.

"We do not pressure or even encourage but provide access, the training and support," McGarry-Schumann continued. "Many providers and their patients want to adopt telehealth or digital solutions but many health plans have not opened up these reimbursement codes. We want to facilitate not dictate care solutions between our provider and patients."

Along with offering the TruClinic technology to network physician practices, Arches has created 30 CPT codes providers can use to get reimbursed for e-sessions.

With 22,000 members, Arches is also pitching the service to hospitals. That could create the opportunity for regional health systems to offer urgent care e-vists on extended hours or even on a round-the-clock basis -- a service similar to LiveHealth in its anytime access, but contained within a plan network or offered by specific health system.

Eventually, physician practices and hospitals may offer telemedicine as part of the patent portal that more and more patients are using to check their medical, email physicians and make appointments.

Whatever the model, though, it seems the service is bound to grow.

"The technology is a lot cheaper than it used to be, but the biggest driver of this, I think, is consumers want to have this convenience," said Jonathan Linkous, the CEO of the American Telemedicine Association.

As insurers invest in telemedicine, they should think about what their member populations need and how to best communicate the options -- for instance, that members might not be able to talk with their own primary care doc at any hour of the day, but that the details of the e-visit will be passed on. Another big factor to consider is how a physician consulting via telemedicine will be able to access a patient's health history, said Linkous.