Recommendations for a permanent telehealth expansion that Congress should consider, including steps to ensure equitable access;
Other non-Medicare recommendations that we believe Congress should prioritize; and
While we generally do not believe additional telehealth guardrails are needed, we offer some options that would be operationally feasible for health care organizations to implement without significantly disrupting patient access to care.
Centers for Medicare and Medicaid Services (CMS): HHS Notice of Benefit and Payment Parameters for 2025 Proposed Rule (11/15) - On November 15, HHS released the Notice of Benefit and Payment Parameters for 2025 proposed rule, proposing standards for issuers and Marketplaces, as well as requirements for agents, brokers, web-brokers, direct enrollment entities, and assisters that help Marketplace consumers. Specifically for telehealth, CMS proposes to mandate that State Exchanges and SBE-FPs require all issuers seeking QHP certification to submit information to the State Exchange or SBE-FP about whether network providers offer telehealth services. These proposals would be effective for plan years beginning on or after January 1, 2025. See also the 2025 draft letter to issuers and additional guidance.
Department of Veterans Affairs: Connecting Veterans to Diabetes Care with Telehealth Innovation (11/14) - Diabetes affects over 30 million Americans. Type 2 diabetes is when the body cannot effectively lower blood sugar levels, and is most common among these adults. Nearly 25 percent of Veterans who receive care from VA have diabetes. Dr. Matt Crowley, endocrinologist at Durham VA, created the Advanced Comprehensive Diabetes Care, which provides critical access to diabetes self-management and medication support through Home Telehealth services. ACDC is uniquely designed to enhance standard home telehealth services and support Veterans with hard-to-control diabetes with three key components: telemonitoring, self-management support and specialist-guided medication management. The program is delivered over six months using existing VA clinical staff and equipment.
The Alliance for Connected Care maintains a tracker on legislation with significant telehealth or remote patient monitoring provisions.
House Energy & Commerce Committee: Health Subcommittee Markup Hearing (11/15) - On November 15, the House Energy & Commerce Committee, Health Subcommittee held a markup and advanced several notable health care bills. Specifically, the Medicare Telehealth Privacy Act of 2023 (H.R. 6364) passed by voice vote. The bill would maintain certain telehealth flexibilities relating to provider privacy under the Medicare program. The bill now go to the full Committee for consideration.
Telehealth Research, Reports and Surveys
California Health Care Foundation: Telehealth Outcomes and Impact on Care Delivery: A Review of Evidence (11/16) - The COVID-19 pandemic rapidly reshaped health care delivery, notably with a surge in telehealth use driven by changes in Medicare and Medicaid reimbursement rates. The ensuing wave of research, spanning over 80 studies from 2021 to 2022, explored the impact of telehealth on health outcomes and care delivery. This literature review examines the concerning lack of examination of disparities among patient demographic groups, such as income, age, language, and race. Also, there are significant gaps in research on telephone-based care, hybrid care, multimodal telehealth, and the use of email, text, and chat for chronic conditions beyond diabetes. Addressing these gaps, future research should offer practical insights to inform policy and practice decisions in the health care delivery system. The absence of studies on disparities in the effectiveness of telehealth services impedes progress toward enhancing access and equity, underscoring the critical role such insights will play in shaping the future of telehealth.
Cadence: Remote Patient Monitoring (RPM) Significantly Improves Health Outcomes and Reduces Total Cost of Care in Hypertension Patients (11/13) - In a study of over 4,000 hypertension patients, Cadence’s remote patient monitoring solution shows reduced total cost of care and positive clinical outcomes. Researchers analyzed hypertension patients who used the remote monitoring platform from health tech company Cadence from February 2022 to April 2023. They had a reduction in both systolic and diastolic blood pressure, and also had lower costs than those who got orders but didn't enroll in the program.
American College of Rheumatology: Telehealth Conversion: A Strategy for Optimizing Ambulatory Access (11/13) - Converting late cancellations and no-show appointments to telemedicine visits increases access to care without the need for rescheduling. Investigators identified adult rheumatology patients with late cancellations (within 24 hours of appointment) or impending no-show appointments from September 2020 to March 2023. Of 624 eligible visits, 516 (83 percent) were converted to telehealth visits. Phone visits were slightly more popular than video visits (54 percent vs 46 percent, respectively). Patients who were older, who lived in a rural area, or who were on Medicare and Medicaid were more likely to opt for phone visits. The intervention resulted in an additional 258 hours of patient care. The reduction in lost revenue for phone vs video telemedicine visits was $7298 ($39.19 per appointment).
Telehealth News and Market Developments
MedCity News: Remote Patient Monitoring: Pioneering Healthcare Through Quality Assurance (11/21) - Remote patient monitoring (RPM) has quickly emerged as one of the most effective tools for improving patient care. By one estimate, 30 million Americans will be using RPM devices by 2024. By 2027, the global market will reach $1.7 billion. By enabling physicians to remotely monitor patients’ health data in real-time, RPM offers a range of advantages that can improve quality assurance (QA) and safety in medical settings. However, with these advantages also comes the need for a robust QA strategy as well to ensure its effectiveness.
Pharmacy Practice News: Telemedicine Bolsters Nutrition Care at Mayo Clinic (11/21) - Nutrition support teams at Mayo Clinic and other health systems are applying the tools of telemedicine to an expanding array of clinical functions, including evaluating patients’ nutrition status, diagnosing probable cases of sarcopenia, assessing the severity of tube site infections, and repairing rather than replacing costly catheters that rupture. Dr. Hurt, Program Director for Mayo Clinic’s Home Parenteral and Enteral Nutrition Program, offered several case studies to demonstrate how telemedicine has been used to improve outcomes of nutrition support patients at home.
Kiplinger: Walgreens Launches Virtual Health Care (11/17) - Walgreens has entered the telehealth space with a plan that let's you chat with a doctor or nurse for $33 or have a virtual visit starting at $36. Currently available in nine states, Walgreens allows patients to consult with a doctor or nurse practitioner about common ailments such as acne, seasonal allergies, urinary tract infections, birth control and emergency contraception, and quickly receive a diagnosis and prescription, Walgreens said. Most visits are available to patients 18 to 64 years old. Insurance for the virtual visits will not be accepted at this time but it can be used to cover prescription costs. The plan, however, is to eventually accept insurance, flexible spending accounts and healthcare savings accounts.
Roll Call: COVID Aid Fuels Telehealth Expansion in Rural America (11/16) - Rural communities see telehealth as a lifeline as hospitals close down. Avel eCare, a telehealth company, launched its ambulance service in November 2022. The South Dakota governor announced a statewide EMS partnership with the telehealth company that same month, funded by a mix of COVID-19 relief money and state general funds. The $1.7 million project aims to connect 60 ambulance agencies by next spring. Avel offers a number of subscriptions to rural providers, including inpatient monitoring, pharmacy support and mental health aid on police calls. First-responders are often volunteers with nonmedical backgrounds, and many rural clinicians don’t always encounter uncommon cases in the small populations they serve. Avel doctors can also help cover overnight shifts, or just serve as a simple backup to a hospital’s lone physician.
MedCity News: Talkspace Tapped To Offer Free Telemental Health Services to NYC Teens (11/16) - Digital mental health company Talkspace will begin offering its telehealth services for free to all New York City teens between the ages of 13 and 17. New York City-based Talkspace works with insurers and employers and offers access to therapy, psychiatry and self-guided mental health support. Through the new program (called TeenSpace) with the New York City Health Department, teens will be able to connect with a Talkspace therapist through phone, video and text. They’ll be able to access the services via computer or smartphone by visiting talkspace.com/NYC, and will have to verify their birthdate and address.The partnership between Talkspace and New York City is a $26 million contract for three years. It comes after the city pledged earlier this year to make mental health services available to teens.
Fierce Healthcare: Pediatric Telehealth Startup Summer Health Expands Text-Based Service into Primary Care for Kids (11/15) - Summer Health launched a year ago as a text-based service for parents to get answers to urgent needs from pediatricians. The startup developed a telehealth messaging platform that aims to answer patients’ medical questions via text in 15 minutes or less. To meet the demand for information and primary care services, Summer Health rolled out Everyday Care, a new 24/7 on-demand text message service for parents to connect with pediatricians, sleep coaches and lactation experts. Families are assigned a lead pediatrician and medical team for continuity of care. The subscription also includes unlimited access to specialists, including sleep coaches, lactation consultants and nutritionists.
Medical Economics: Combatting Staff Shortages with Outsourced Remote Patient Management (11/15) - Many practices are adopting remote patient monitoring (RPM) to help address patient needs while easing the burden on providers. RPM helps health care providers keep closer tabs on the health status of individuals with chronic diseases such as diabetes, high blood pressure, heart disease and obesity, without requiring in person office visits.
Forbes: Advancing Health Care Through Enhanced Patient Adherence To Monitoring Devices (11/14) - Patient adherence to the technologies associated with remote data collection is crucial for the success of RPM and clinical trials. Reliable data collection hinges on patients following the directions for using RPM devices to fully maximize their potential. Providers, researchers and developers must understand the differences in patient adherence between clinical trials and healthcare settings. They can develop tailored strategies and solutions for optimizing adherence, enhancing patient outcomes and improving trial data quality.
Inside Telehealth: (Subscription Required) RPM Company Calls On Congress, CMS To Invest In Digital Health (11/13) - One of the country’s largest remote physiological monitoring service providers, Cadence, is calling on Congress to up CMS reimbursement levels for remote monitoring to allow expansion in rural areas and to give the agency resources to measure digital health outcomes. Cadence pitched the proposals in its response to House Ways & Means Chair Jason Smith’s (R-MO) recent request for information on ways to improve rural health care. To increase RPM uptake in rural areas and promote equity, Cadence asks Congress to do two things: Pass legislation setting a floor payment for RPM at the national average payment level and allocate federal dollars to research whether digital health saves health care dollars.