The COVID-19 Crisis and the Expansion of Telehealth Services
The novel coronavirus (COVID-19) public health emergency across the United States has made telehealth an indispensable tool to both providers and patients alike. As the number of cases of confirmed COVID-19 patients skyrocket, urgent and emergency care providers must triage care for affected patients while maximizing protections for themselves and their staff. Accordingly, telehealth has become a potentially life-saving instrument to provide care for a wide variety of COVID-19 and non-COVID-19 patients alike.
Prior to the COVID-19 crisis, telehealth and the technology on which it relied had faced barriers to development, including hesitation on the part of both providers and patients to accept telehealth as a reasonable substitute for in-person treatment. As the current public health emergency has proven, however, telehealth technology allows health care providers to deliver cost-effective care while keeping health care workers, patients, and vulnerable populations safe, vindicating health care payors that have long advocated for increased use of telehealth.
Common telehealth technologies include videoconferencing, store-and-forward imaging, streaming media, and landline and wireless communications. The virtual visits are quickly replacing the bulk of in-office doctor’s appointments for everything from routine checkups to chronic disease management.
Increasing availability of information and communication technologies to the general population has been the biggest driver of telemedicine over the past decade, rapidly creating new possibilities for health care service and delivery. The replacement of analogue forms of communication with digital methods, combined with a rapid drop in the cost of information and communication technologies, has sparked significant interest in the application of telehealth among health care providers, and has enabled health care organizations to imagine and implement novel and resourceful ways of providing care.
Moreover, telehealth practitioners utilize these technologies to overcome geographical barriers and increase access to health care services. This is particularly advantageous for rural and underserved groups in developing countries – groups that customarily suffer from lack of access to health care. In low-income countries and in regions with limited infrastructure, telehealth applications are mainly used to link health care providers with specialists, referral hospitals, and tertiary care centers.
Relevance During COVID-19 Public Health Emergency
From being used to evaluate patients for possible COVID-19 symptoms to advising on whether COVID-19 testing is recommended where available, telehealth ultimately allows sick (or potentially sick) people to stay home and slow the spread of the disease. Converting to telehealth also provides the benefit of lessening the concerns about adequate personal protective equipment. Although many hospitals and private practices have reworked their waiting rooms to promote social distancing and patients are recommended to call ahead so physicians and staff can be ready, telehealth services allow for optimal first stage triage of potentially infected patients.
Finally, by using virtual care for regular, necessary medical care, and deferring elective procedures or annual checkups, medical staff and equipment needed for the COVID-19 public health emergency are freed up.
Coverage By Insurers
Following President Trump’s emergency declaration, the Centers for Medicare & Medicaid Services (CMS) broadened access to Medicare telehealth services so that beneficiaries can receive a wider range of services from their doctors without having to travel to a health care facility. Specifically, CMS expanded the telehealth benefit on a temporary and emergency basis under the 1135 waiver authority and Coronavirus Preparedness and Response Supplemental Appropriations Act (Phase 1). Under the new waiver, beginning March 6, 2020 and for the duration of the COVID-19 public health emergency, Medicare is able to pay for office, hospital, and other visits furnished via telehealth across the country, including in patients’ homes. A wide range of health care providers, such as doctors, nurse practitioners, clinical psychologists, and licensed clinical social workers, are also able to offer telehealth services.
Notably, the HHS Office for Civil Rights (OCR) also announced on March 17, 2020 that it will exercise enforcement discretion and waive penalties for HIPAA violations against health care providers that serve patients in good faith through everyday communications technologies, such as FaceTime or Skype, during the COVID-19 nationwide public health emergency.
Private health insurers are also following suit and expanding policies around telehealth services for Medicare, Medicaid, and commercial membership. For example:
- Through June 18, 2020, United Healthcare is allowing eligible medical care providers who have the ability and want to connect with their patient through live videoconferencing to do so. Benefits will be processed in accordance with the member’s plan.
- Aetna is offering zero co-pay telemedicine visits for any reason. It is also extending its Medicare Advantage virtual evaluation and monitoring visit benefit to all fully insured members.
- Anthem recently announced that for 90 days, its plans will waive any cost sharing for telehealth visits, including visits for mental health care, for fully insured employer plans, individual plans, Medicare plans, and Medicaid plans, where permissible. This includes visits using Anthem’s telemedicine service, as well as care received from other telehealth providers delivering virtual care. Anthem is also increasing physician availability through its telemedicine service, LiveHealth Online (LHO), and is encouraging in-network doctors to join the platform, given the surge in demand.
- CareFirst has announced that for telemedicine accessed through a CareFirst Video Visit, copays, coinsurance, and deductibles will be waived for the duration of this public health emergency — including behavioral health, lactation support, nutrition counseling and urgent care services.
- Cigna is making it easier for customers with immunosuppression, chronic conditions or who are experiencing transportation challenges to be treated virtually by in-network physicians with those capabilities, through May 31, 2020.
The Future of Telehealth and Other Trends
Whereas virtual care companies are currently struggling to meet demand (e.g. long waits in virtual waiting rooms), moving forward we will likely see more sophisticated use of telehealth tools. A crucial question will be whether Medicare will continue to cover virtual care services, as the current allowances are scheduled to be in place only for as long as the COVID-19 national emergency is designated.
States are also increasingly issuing guidance and allowing for greater flexibility that could impact the availability of telehealth option, including permitting providers located out of state/territory to provide care to another state’s Medicaid enrollees impacted by the emergency; and temporarily suspending certain provider enrollment and revalidation requirements to increase access to care. These changes will likely continue over the course of the next year as the COVID-19 crisis unfolds but could also potentially impact how states approach telehealth once the crisis is over.
Notably, for payors, continued use of telemedicine in the future will ultimately allow for higher utilization (through a more efficient model of care), which can lead to reduced costs; reduced cost structures and improved quality scores; and increased member satisfaction and loyalty. Moreover, payors also have fewer costs when specialists are available via telehealth to address specific concerns leading to a higher reduction of potential costs. As such, health care payors have long been staunch supporters of increased adoption of telehealth services in delivery of care.
Ultimately, the future looks bright for the increasing prominence of telehealth in health care, so long as companies can keep up with the surge in demand and the government endorses the continued need for telehealth following the COVID-19 public health emergency. For now, it has proved an invaluable resource in providing improved access to care during the pandemic.