Please find below updates on how the health care system is leveraging telehealth and remote patient monitoring - including research, data, and polling on its current use in response to COVID-19.
Krista Drobac, Executive Director, Alliance for Connected Care
When asked about the prospects for long-term telehealth coverage, I often hear people say that permanent expansion is inevitable because "the genie is out of the bottle" or "Congress never takes benefits away."
The truth is they can, and they will, unless we effectively break down persistent misconceptions about the impact of telehealth policy changes. If we can't do it quickly, we should pivot to asking Congress for an extension of the pandemic flexibilities, thereby affording the industry more time to support the formal publication of government studies and peer-reviewed research that bears out the cost-effectiveness, quality and access expansion of telehealth.
Myth No. 1: Lifting Medicare telehealth restrictions will cost the program money
Myth No. 2: Patients aren't seeing their own doctors
Myth No. 3: Telehealth is uniquely subject to fraud
Myth No. 4: In-person relationship requirements are necessary to mitigate excessive cost and fraud
Myth No. 5: The Biden administration has the authority to make the telehealth changes permanent
Centers for Medicare & Medicaid Services (CMS): Summary Report on Permanent Risk Adjustment Transfers for the 2020 Benefit Year (6/30) – CMS released their annual summary risk adjustment report. CMS transferred a total $11.17 billion between small group and individual plan insurers under the Affordable Care Act’s budget-neutral risk adjustment program in the 2020 benefit year. The RA report also highlights the growth in telehealth usage during the pandemic, with telehealth claims jumping by 484% compared to 2019, while total paid claims only slightly increased.
The impact of the pandemic and how enrollees accessed healthcare was evident in the significant increase in telehealth usage, although there was only a slight increase in total paid claims costs when compared to the 2019 benefit year.
The 2020 benefit year saw an increase of approximately 484.0% in telehealth paid claims amounts when compared to the 2019 benefit year.
Telehealth claims have specific codes for various length of service visit. The 2020 benefit year telehealth paid claims amounts by duration when compared to 2019 were as follows:
1-10 minute visit paid claims cost increased by approximately 290.8%
11-20 minute visit paid claims cost increased by approximately 667.2%
21-30 minute visit paid claims cost increased by approximately 1074.1%
CMS: CMS Announces Director of Center for Medicaid and CHIP Services (6/28) – CMS announced Daniel Tsai as Deputy Administrator and Director of Center for Medicaid and CHIP Services (CMCS). Tsai will lead the Center’s efforts in addressing disparities in health equity and serving the needs of children, pregnant people, parents, seniors, and individuals with disabilities who rely on these essential programs. Previously, Dan Tsai served as the Assistant Secretary for MassHealth and Medicaid Director. In April, he spoke at a joint hearing of the Massachusetts House and Senate Committees on Ways and Means about telehealth and telebehavioral health saying, “Tele-behavioral health can help improve the efficiency and effectiveness of our provider workforce and remove unnecessary obstacles to provide treatment for MassHealth members who have difficulty leaving their home environment, who live in rural areas, and or have other unique needs.” Daniel Tsai will start on July 6.
State Telehealth Activity
National Law Review: Florida Ends Telehealth Waivers – Department of Health Issues Update (7/2) – Florida’s telehealth emergency waivers ended on June 26, 2021 after Governor DeSantis allowed COVID-19 emergency waivers to expire. The Florida Department of Health issued guidance on how the expiration of these emergency orders affect telehealth services in the state, which includes that out-of-state health care providers are no longer authorized to provider telehealth services to patients in Florida unless they are licensed or registered to do so. No glide path, such as a 60-day advance notice, were provided to allow time to transition. The Florida Medical Association stated it will push to reinstate telehealth expansions and make them permanent during the next legislative session.
Foley & Lardner LLP: New York Ends Telehealth Waivers; Issues New MedicaidGuidance (6/30) – New York Governor Andrew Cuomo issued an announcement that the state’s telehealth emergency waivers have expired, with the announcement stating the orders are no longer necessary. While out of state providers are no longer able to render services to patients in the state unless licensed in New York, New York State Department of Health issued guidance on the state Medicaid program’s continued coverage of telehealth service for the duration of the federal Public Health Emergency. The guidance is designed to maintain the ability of Medicaid providers to use telemedicine and digital health to deliver health services for the remainder of the federal PHE and will remain in effect until it expires.
MNSRC: Senate Approves Health & Human Services Budget that Supports Mental Health, Minnesota’s Most Vulnerable and Prioritizes Lower Health Care Costs for Minnesotans (6/29) – The Minnesota Senate approved a new budget for health and human services, which prioritizes telehealth and other key health care priorities. The budget includes telehealth reforms that would improve access and lower health care costs, expand telehealth services, and permanently add mental health and substance use disorder to the list of eligible services.
1011 Now:Gov. Ricketts to end coronavirus State of Emergency, Test Nebraska program (6/28) – Nebraska Governor Pete Ricketts announced he will allow all but three of the state’s emergency declarations to expire on June 30. One of the executive orders being extended involves telehealth and will be extended until August 27, as new legislation around telehealth takes effect on August 28.
Telehealth Research, Reports and Surveys
Partners Health Plan:New Partnership Improves Care and Reduces Costs for People with Disabilities (July 2021) – Partners Health Plan (PHP), a managed care organization dedicated to providing support and services to individuals with intellectual and/or developmental disabilities (I/DD) in the New York downstate region and StationMD, a telemedicine solution that offers immediate access to board-certified doctors who are specially trained in the medical care and challenges of individuals with I/DD partnered to improve access to medical care for people with I/DD. A year later, data demonstrates that the partnership significantly reduced the need for Emergency Room (ER) visits and hospitalization, thus reducing medical costs for patients and payers.
The 12-month pilot program demonstrated:
Of the approximately 1,100 PHP members who have access to the StationMD’s telehealth service, there were 679 calls to StationMD.
StationMD was able to resolve 90% of patients’ medical matters virtually.
Over 12 months, the specialized service allowed:
PHP to avoid spending up to $2.2 million in ER and hospitalization costs
PHP to avoid spending up to $20,800 in transportation costs
A savings of up to $1,900 per member on medical cost
West Virginia University: Telehealth pilot program shows promise in helping former nursing home, long-term care facility residents remain safe and healthy in their homes (6/30) – Preliminary results from a new West Virginia University Office of Health Affairs pilot program shows that telehealth can help patients transitioning home after a stay in a nursing home or long-term care facility remain healthy and happy in their own communities. Customized medical equipment is provided to participants through vendors established through the pilot program. Tablets are provided for participants who can connect to the internet, but the pilot is also available to participants who simply have a landline telephone — what Davis calls “the original telehealth.” He cited one noteworthy success story in which a participant experienced hypertension after being discharged from a nursing home. Through the telehealth pilot, a nurse was able to coordinate the individual’s care by calling the primary care provider to get their blood pressure medication adjusted without the need for an emergency department visit or hospitalization.
University of North Florida: UNF receives COVID-19 Research Accelerator Grant from the Bill & Melinda Gates Foundation (6/28) – UNF will receive funding towards a project on “Telehealth Disparity: Investigating the Predictors for Low Utilization among Minority Populations.” Their research will investigate social determinants of health, health status and health behavioral causes for low telehealth utilization. Dr. Cynthia Williams, health administration associate professor in the Brooks College of Health, and Dr. Richard Shang, management assistant professor in the Coggin College of Business will examine cross-cultural factors, gender differences and other social factors that contribute to inequities in access and health outcomes. This work will inform socially and culturally sensitive interventions to promote equity in technology-enabled healthcare among minority populations. UNF research will begin this summer and will be featured in the COVID-19 Research Database Grand Rounds webinar series later this year.
Trilliant Health: 2021 Trends Shaping the Post-Pandemic Health Economy (June 2021) – A new report by Trilliant Health breaks down telehealth utilization rates and patient attitudes around receiving care in the home. Their findings were based on over 70 billion medical claims data representing 309 million patients across all 50 states, including private insurance and Medicare claims. They found that 80 percent of consumers say they would be willing to use home care models (like Hospital at Home) if they were covered by insurance.
Telehealth News and Market Developments
mHealth Intelligence: Cincinnati Children’s Integrates Telehealth Into Suicide Prevention Study (7/2) – Researchers at Cincinnati Children’s Hospital Medical Center are using a nearly $8 million in funding from the Patient-Centered Outcomes Research Institute (PCORI) to examine how connected health tools and platforms might be used to enhance or improve treatment options for adolescents with suicidal thoughts.
Politico: Virtual care becomes a common cause in a divided Congress (6/30) – Lawmakers are lining up to decide what Medicare will pay for after the pandemic is over, with sponsors of a leading Senate plan confident they have the votes to include it in a must-pass piece of legislation this year. Telehealth lobbyists so far have failed to get extensions into Covid relief packages, in part due to concern over how they could drive up health spending and potentially invite fraud. “We've gone from the point where if I talked about telehealth to someone their eyes would start to glaze over,” Brian Schatz (D-Hawaii) said. “Now when I start to talk about telehealth, their head nods vigorously up and down.” Advocates have said the legislation would be a win for patient access and medical care and point to support from numerous provider groups such as the American Medical Association.
Healthcare IT News: Metro Health's telehealth and RPM program is helping patients avoid hospital stays (6/29) – Metro Health, an osteopathic teaching hospital serving more than 250,000 patients per year throughout western Michigan, has been using telehealth and RPM to monitor COVID-19 patients by using biometric and symptom monitoring, medication and monitoring reminders, patient communication through voice calling and virtual visits, and a COVID-19 care plan. Results have been dramatic – Metro Health recorded a 95% patient satisfaction rate among COVID-19 patients enrolled in the telehealth and RPM program. Furthermore, the organization achieved a 90% adherence rate across the biometrics, meaning that, while enrolled, 90% of patients were recording their biometrics daily.
mHealth Intelligence: Florida Research Project Tackles Low Telehealth Access in Minority Populations (6/29) – The University of North Florida is launching a project with funding from the Bill & Melinda Gates Foundation to examine how social determinants of health may be driving low telehealth access in underserved communities. Researchers will “examine cross-cultural factors, gender differences and other social factors that contribute to inequities in access and health outcomes,” according to a press release around the launch. The research will help inform interventions to promote equity in technology-enabled health care among minority populations.
HHS Agency for Healthcare Research and Quality (AHRQ): Asking the Hard Questions About Telehealth (6/28) – AHRQ Acting Director Meyers issued a blog noting that questions remain about the use, quality and appropriateness of telehealth. He states that the time is now to create the evidence to ensure telehealth drives improvements in quality, safety, equity, access and value. This work has been helpful. But we can, and must, do more. We no longer can ask “Should healthcare delivery embrace telehealth?” but instead ask “How can we learn from the use of telehealth today to ensure care is better tomorrow?” Stakeholders across the healthcare landscape—payers, policymakers, clinical professionals, and patients—need reliable information about the ways telehealth can best be integrated into healthcare delivery to drive quality, safety, equity, and value.
HIMSS TV, “Using IT to ensure smooth transitions of care.” Central Logic CMO Dr. Darin Vercillo discusses how health systems via IT can best orchestrate operations, most notably patient transfers and discharges to post-acute care.