Please find below the latest developments in federal and state virtual care policy as well as research, data, and polling on the use of virtual care.
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Alliance News
MedTech Intelligence: Telemedicine Moved Forward During the Pandemic. Our Policies and Regulations Need to Catch Up (4/22) – Outdated policies and regulations threaten to bring progress to a standstill, restrict vital telehealth access to millions of Americans, and exacerbate health inequities. All 50 states and the District of Columbia, as well as CMS, waived state licensure requirements so physicians could treat patients virtually across state lines during the pandemic. These flexibilities opened up a wave of record-breaking new investments in digital health technology, providing patients with new options in telehealth services and remote-monitoring solutions. However, according to a tracker
by the Alliance for Connected Care, only 23 states still have those licensure waivers in place, and the future remains unclear for expanded telehealth benefit coverage and loosened prescription regulations. Permanently eliminating geographic and financial barriers to telemedicine is essential to reducing the health care access gap, providing consumers with greater choice in their medical care, and encouraging continued innovation in the digital health space.
Politico Pro: Telehealth growing pains (4/20) – The telehealth industry faces some uncertainty as more states end waivers allowing care across state lines. As many states’ emergency regulations permitting such care wind down and the patchwork system of state rules becomes patchier, millions of patients are losing expanded access to telehealth. The Alliance for Connected Care
has proposed a voluntary national system, similar to the driver’s license system, that would enable states to recognize each other’s licenses. Patient advocates, public health officials and telehealth and provider groups are pushing for utilization of telehealth across state lines.
Inside Telehealth: GAO’s Call For CMS to Gauge Medicaid Telehealth Use Poses Challenges (4/20) – The Government Accountability Office (GAO) recently released a report which asks the Medicaid program to gauge the quality of telehealth during the pandemic. Based on Medicaid data collected across five states, GAO found exponential increases in the number of services delivered via telehealth and the number of Medicaid beneficiaries receiving such services. Specifically, 32.5 million telehealth services were delivered to Medicaid beneficiaries via telehealth from March 2020 to February 2021, compared to 2.1 million services the prior year. According to Krista Drobac, Executive Director of the Alliance for Connected Care, “Medicaid agencies were already stretched thin before the pandemic, it would have been challenging for them to collect data while they were rolling out new services. It's an incredible amount of work that everyone is doing so when you switch over to using telehealth, it's not surprising that they didn't necessarily have all the mechanisms in place to measure its impact.”
Politico Pro: Millions set to lose telehealth access across state lines as waivers wind down (4/19) – Millions of patients are losing expanded access to telehealth across state lines as many states’ pandemic emergency declarations wind down, prompting patient advocates, public health officials and telehealth and provider groups to call on states and Congress for a fix.
According to data from the Alliance for Connected Care, states could see expanded access lapse in the second half of the year, with flexibilities intact for 15 states, down from 24 in early March. Access to virtual care across state lines, which patients increasingly took advantage of during the pandemic, is overwhelmingly popular among patients and providers. National data on the rise of care across state lines is sparse, but one in five providers say they provided care across state lines amid the pandemic, according to a recent Morning Consult poll conducted on behalf of the Alliance for Connected Care.
American Academy of Audiology: New Survey of Both Practitioners and Patients Demonstrates the Value of Telehealth (4/19) – The Alliance for Connected Care recently released the results of a major survey of both health care patients and practitioners, conducted by Morning Consult on the Alliance’s behalf. The poll asked patients and practitioners about their telehealth usage, telehealth experiences, their use of care across state lines, and the workforce implications of these developments. Key takeaways from the survey include that both patients and providers have had a positive experience with telehealth, patients and providers alike believe that telehealth is increasing access to care, and both patients and providers support the use of telehealth across state lines.
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Administration
Inside Telehealth: Telehealth Not Mentioned in White House Plan To Boost Substance Use Treatment (4/21) – The White House released its National Drug Control Strategy on April 21, which calls for federal agencies to increase access to substance use treatments as part of a broader strategy to address the opioid overdose epidemic. However, the Strategy makes no mention of allowing drugs to be prescribed via telehealth. The Administration faces pressure from key lawmakers and stakeholders to continue COVID-19 public health emergency flexibilities that have allowed controlled substances, like the substance use disorder treatment buprenorphine, to be available through telehealth.
Department of Veterans Affairs: VA telehealth makes VA care accessible to women Veterans (4/15) – VA telehealth ensures that Veterans can receive the care they need even when they are far from their VA facilities. Veterans can use an internet-connected device to access care from any location, even in remote areas, at home or in a clinical setting. Some VA medical centers now feature nursing rooms for mothers and separate entrances for women to ensure privacy. Primary care services have integrated telehealth. Women Veterans program managers are available at each VA medical center nationwide to assist women Veterans and coordinate services.
US Department of Agriculture: Biden-Harris Administration and USDA Establish New Program to Support Rural Health Care Providers, Including through Telehealth (4/13) – The US Department of Agriculture (USDA) announced awards of the Emergency Rural Health Care Grants, investing $43 million into upgrades to health infrastructure in rural areas that include several telehealth programs. The grants will help rural hospitals and health care providers, including in rural Mississippi
and Arizona, to implement telehealth and nutrition assistance programs, increase staffing to administer COVID-19 vaccines and testing, build or renovate facilities and purchase medical supplies. For more coverage, see mHealth Intelligence or Inside TeleHealth.
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During the public health emergency, all 50 states and the District of Columbia used emergency authority to waive some aspect(s) of state licensure requirements to facilitate patients getting care. The Alliance for Connected Care maintains a chart outlining which states have lifted their COVID-19 emergency waivers, and how this has impacted telehealth and licensing flexibilities in each state. As of April 18, 15 states still have licensure flexibilities in place.
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Telehealth Research, Reports and Surveys
mHealth Intelligence: Hispanic Patients Used Virtual Care Less After COVID-19 Diagnosis (4/19) – A study published in BMC Health Services found that Hispanic and Latino individuals are significantly less likely to use, and therefore benefit from, virtual primary care as compared to White populations. Researchers found that virtual primary care increased significantly between the pre- and mid-COVID-19 periods, rising from 3.6 percent to 10.3 percent. However, in-person primary care remained relatively stable, dropping only slightly from 21 percent to 20.7 percent. While social vulnerability measures did not appear to impact virtual primary care use, individuals living in areas characterized as vulnerable based on minority status, language, housing type, and transportation were less likely to use in-person primary care than people living in areas not characterized as vulnerable in these ways. Researchers concluded that the expansion of virtual care amplified disparities in care access, as specific individuals had less access to certain necessary resources.
Forbes: Telemedicine Fails to Counter Healthcare Disparities During The Pandemic (4/19) – A recent study by the University of Houston found that racial and ethnic disparities persisted in telemedicine. The research suggested that the promise of the positive impact of telemedicine on health care use and health outcomes could elude underserved populations. The research found that African Americans were 35 percent less likely to use telemedicine than white Americans. Hispanic people were 51 percent less likely than white people to have a telemedicine visit and Asian people and American Indian/Alaska Natives and Pacific Islanders were also less likely to use telemedicine. However, the research did find that the further away someone lived from their clinic, the more likely they were to use telemedicine and that this held true for African American and Hispanic patients. Researchers emphasized that clinics will need technology support staff to conduct pre-visit device and connectivity testing with patients, which can be instrumental in helping patients maximize telemedicine as an option to access care.
U.S. News & World Report: Mental Health vs. Primary Care: How Americans Are Using Telehealth (4/19) – Social workers and psychiatrists are among the providers Americans are frequently visiting via telehealth, highlighting the pandemic’s continued mental health impact. According to new evidence from private insurance claims data, the top specialty providing telehealth services nationally this past January was social work. This is just one sign of how prevalent the provision of mental health services through telehealth has been, as our country continues to grapple with the pandemic and its impact on many fronts.
mHealth Intelligence: Genetics and Behavioral Health Pediatric Subspecialists Use Telehealth Most (4/18) – A recent study
found that pediatric telehealth use was inconsistent across subspecialties, with genetics and behavioral health subspecialists using the care modality the most. Among subspecialties that used telehealth less frequently, like cardiology, orthopedics, and urology, the utilization rate was six percent to 29 percent. Among those that used telehealth at a higher rate, such as genetics, behavioral health, and pulmonology, virtual visit utilization ranged from 38.8 percent to 73 percent. Additionally, Hispanic patients and patients who spoke in a primary language other than English were less likely to participate in a telehealth visit. Researchers concluded that telehealth use among pediatric patients was inconsistent among different subspecialties, likely due to varying access levels to technology and barriers that arose from the COVID-19 pandemic.
Business Wire: Recent Study Highlights the Outcome and Safety Benefits of Remote Patient Monitoring During the Pandemic and Beyond (4/18) – A study
published in the Journal of American Medical Association (JAMA) found that, through recent technological advances in remote monitoring, a patient’s physiological needs can now more often be the primary factor in determining the level of monitoring they receive, rather than their physical location. The study projected that remote monitoring could potentially be associated with 87 percent fewer hospitalizations, 77 percent fewer deaths, reduced per-patient costs of $11,472 over standard care, and gains of 0.013 quality-adjusted life-years. Researchers concluded that the shift of monitoring should be based on need and not location.
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State Telehealth News and Activity
State of Reform: Texas behavioral health clinic expands access to telehealth through mobile app (4/21) – The University of Texas Health Science Center at San Antonio and its Be Well Texas project made its mobile app WEconnect Recovery available for free download to all Texans struggling with substance use disorder and mental, emotional, and behavioral health issues. UT Health San Antonio operates a Be Well Texas clinic that offers low-barrier, convenient access to evidence-based treatment through statewide telehealth and recovery support services for its patients by virtual or in-person appointments. The WEconnect Recovery app enables users to earn rewards through tracking and completing support and self-care activities.
News Center Maine: Maine State Library kicks off ‘libraries health connect program’ for rural Mainers (4/21) – Maine State Library launched the Libraries Health Connect Program. Beginning in May, residents who live in 10 communities across rural parts of the state will have the ability to connect with a health care provider virtually, as the program provides the technology, space, and equipment needed for telehealth services through the public library. The state library allotted $50,000 received through the American Rescue Plan Act to create the statewide telehealth initiative.
PR Newswire: Telehealth is a Lifeline for California Veterans at Confidential Recovery (4/19) – Confidential Recovery, an outpatient treatment program in San Diego that is designed to help Veterans, first responders, and executives achieve sustainable recovery from substance use disorder, has expanded its telehealth offerings. Confidential Recovery's telehealth clients will participate in 'one-on-one' addiction counseling, and can also be set up in the room with other 'live' participants in group counseling sessions, giving them a sense of belonging and camaraderie. For some Veterans, the telehealth option is a matter of convenience, and they attend sessions both in person, and via telehealth, depending on their work schedules and other commitments.
Inside Telehealth Policy: Providers to Face Patchwork Of State Telehealth Policies Post PHE (4/19) – According to the Center for Connected Health Policy, the end of the public health emergency will bring with it diverse and conflicting state approaches to telemedicine, forcing telehealth providers to navigate differing and evolving state reimbursement requirements under Medicaid and private insurance. When the pandemic began, states all took slightly different approaches to their telehealth policy. Those state policies have continued to evolve, meaning the approach to reimbursement for virtual care will continue to be very different from state to state regardless of what direct federal Medicare policy takes when the PHE ends.
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Telehealth News and Market Developments
Beckers Hospital Review: Locum Tenens + Telehealth: Expanding Care & Increasing Physician Satisfaction (4/21) – With a shortage of physicians across the country, many organizations are turning to experienced locum tenens providers -- physicians and advanced practitioners -- to staff telehealth roles in specialties such as internal medicine, primary care, radiology, behavioral health and cardiology. Organizations are drawn to these professionals because of the flexibility to work full-time or part-time – for a range of a few days to up to six months or more – in all major clinical specialties. Additionally, locum tenens and advanced practice providers are willing to fill shifts an organization’s employed physicians typically prefer not to carry, such as after-hours coverage, which helps to reduce burn-out and improve satisfaction levels. With locum tenens physicians and advanced practice providers providing the backbone of telehealth and virtual care offerings, health systems can remove the physical barriers between patients and care providers, resulting in greater access to care, increasing touchpoints, and improving patient satisfaction and outcomes while reducing rehospitalizations and stress on their employed physicians.
mHealth Intelligence: Loyola Medicine Adds American Sign Language Feature for Telehealth (4/20) – Loyola Medicine, a medical center in Chicago, implemented an American Sign Language (ASL) feature to assist deaf and hard-of-hearing patients participating in virtual appointments. Implementing the ASL feature will allow the team to care for more patients and improve the quality of care delivered. Providing language accessibility will help reduce barriers in accessing telehealth and other health services.
MobiHealth News: Dental care company quip scoops up dental telehealth company Toothpic (4/20) – Dental care company quip plans to acquire dental telehealth company Toothpic. The acquisition will allow quip users to access both preventative digital checkups and on-demand virtual emergency dental care. The services will be wrapped into quip's digital platform, which lets users track oral hygiene habits and monitor health over time. By embedding Toothpic’s teledentistry platform and nationwide network of online dental professionals into the app, quip will be able to centralize access to a full suite of connected oral care products and dental services that will alter the way people experience and manage their oral health.
Healthcare Dive: Icario Launches Digital Bridge Program to Help Medicaid and Medicare Plans Improve Broadband Access and Digital Literacy for Members (4/19) – Icario announced the launch of Digital Bridge, a new program that Medicaid and Medicare plans can use to improve broadband access and education to members. Digital Bridge provides plans with the resources they need to inform members on the availability of free or low-cost devices, broadband internet service, hotspots, and the education and technical support they need to use these tools to take health actions.
MedCity News: How digital health is challenging traditional reimbursement models (4/19) – Reimbursement systems need to work for new health care technologies like remote patient monitoring and telehealth tools. During the COVID-19 pandemic, Medicare established payment parity for telehealth, resulting in higher utilization of telehealth. As CMS continues to introduce new codes to support remote patient monitoring, telehealth, and digital therapeutics, among others, this will help increase the shift towards value-based care.
Healthcare IT News: Geisinger's journey to greatly expanded telehealth (4/19) – Geisinger Health System, a health system that mainly serves rural counties throughout central and northeastern Pennsylvania, is now able to offer telemedicine appointments to patients for primary care, urgent care and more than 70 specialties. Geisinger was awarded $978,935 by the FCC for tablet computers, remote monitoring equipment and telehealth platform licenses to maintain a high level of access to care by providing telehealth visits for primary care appointments and all 72 health care specialties within the medical center. With broadband support from the federal government, rural hospitals are able to provide telehealth to their patients.
The Hill: Maintaining telehealth access is key to advancing health equity (4/18) – Telehealth improved access to health care services for millions of people without requiring them to leave their homes during the pandemic. With the value of telehealth now demonstrated, it is important that it be permanently integrated into the health care system as an option for patients and health care providers and that barriers to its usage, such as the need for broadband or video/smart technology, be addressed to assure full access by all patients where they are.
Healthcare IT News: Asynchronous Telehealth Boosts Provider and Patient Experience (4/18) – Baptist Health, a health system based in Kentucky, implemented asynchronous telehealth to address their primary care access issue. With capacity constraints across Baptist Health's primary and urgent care venues, ensuring that the asynchronous telemedicine technology is helping to reduce strain on providers and create more efficiencies is a top priority. They have seen a big surge in use of telehealth, which has allowed their team to deliver care for low-acuity conditions using the technology.
Forbes: From Telehealth Experiments to Digital Health Potential: What to Expect from A Changing Industry (4/18) – The COVID-19 pandemic has demonstrated the adoption of at-home testing with the integration of digital technologies. Telehealth allows diagnostics to occur without a visit to the hospital, a physician’s office, or a pharmacy. The momentum continues with telehealth companies testing risk-sharing contracts and getting paid for services like in-app messaging, medication reminders and digital coaching, in addition to virtual doctors’ appointments. Telehealth is no longer a luxury, but an integral part of a health systems’ care strategy.
Worcester Business Journal: New technologies are aiming to address problems in providing rural health care (4/18) – Telehealth services have improved medical outcomes in hard-to-reach areas like rural communities. Lack of transportation combined with the long proximity away from medical centers are some of the major hurdles residents in small towns must overcome to receive medical treatment. Telehealth was quickly adopted during the COVID-19 lockdown. However, rural communities cannot fully take advantage of the benefits of telehealth due to broadband issues. For rural residents who lack internet access, telehealth can be administered via telephone, indicating the importance of allowing audio-only telehealth to continue after the pandemic.
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Upcoming Events
May 5 – Duke Margolis Center for Health Policy, “Equitable Access to Care: Leveraging Telehealth for Medicaid Beneficiaries in North Carolina.”
May 16-17 – Health Resources and Services Administration (HRSA), “National Telehealth Conference.”
June 1 – American Academy of Neurology & American Medical Association, “Clinical Case Study: Telehealth for Neurology.”
June 1-2 – Becker’s Healthcare, “The Shift to Digital Virtual Event – Telehealth, Home Health and Virtual Care.”
Previous Events, Videos, & Podcasts
We Talk Health, “Is Telehealth Still Relevant?” On this episode of We Talk Health, Will Kwasigroh travels to Dyersburg, TN to talk with April Walker, a Nurse Practitioner at West Tennessee Medical Group Primary Care Caruthersville, to talk about telehealth. Will and April dive into the benefits of telehealth and how it is a very useful tool, especially for the rural community that she serves in Missouri. Telehealth is a great way to be seen by a provider that doesn’t require you to physically be in the doctor’s office.
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