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.
Health Affairs: Policy Spotlight with CMS Administrator Chiquita Brooks-LaSure: (8/12) – Health Affairs held its third “Policy Spotlight” speaker series event, which featured Chiquita Brooks-LaSure, Administrator of the Centers for Medicare and Medicaid Services (CMS). Health Affairs Editor-in-Chief Alan Weil interviewed CMS Administrator Brooks-LaSure for this in-depth discussion on the Biden Administration’s health care plans and priorities for CMS and CMMI. Topics discussed included advancing health equity through CMS and CMMI models, focusing on patient-centered care, accelerating integration with social determinants of health, and the future of value-based payments and telehealth. CMS Administrator Brooks-LaSure discussed the impacts of telehealth in the mental health space, and noted the need to ensure telehealth is provided equitably. Watch the recording here.
Healthcare IT News: OIG looking closely at telehealth as it weighs future enforcement (8/11) – In a HIMSS21 session with updates on the HHS inspector general's oversight and compliance efforts, officials said they plan to ensure virtual care is provided with integrity, and will take aim at telehealth fraud schemes. Andrew Vanlandingham, senior counselor for Medicaid Policy and acting health IT lead at OIG said OIG is "working hard to assess how telehealth utilization changed during the pandemic – what that means for corporate integrity, what that means for access, what that means for health equity. We have roughly eight audits and studies ongoing right now that we hope will really be the first down payment for OIG to be part of the broader conversation about what telehealth will look like after the pandemic." The goal is to "help the health technology community and providers as they continue to refine their development of telehealth and enhance virtual care," he said. The Alliance for Connected Care is supportive of OIG’s work to distinguish between fraudulent telemarketing and legitimate telehealth. We look forward to results of the OIG’s telehealth audits.
The costs of an ambulatory telehealth visit is on average around $40 lower compared to an in-person visit.
Some telehealth services like ambulatory care take up lower physician time than in-person services, but some specialty telehealth services like surgery take up higher physician time.
Physician professional organizations prefer payment parity for telehealth services.
Patients and payers prefer the same level of telehealth services that were available and provided during the pandemic.
In a study examining over 7 million private payer outpatient claims between 2010 and 2015, the investigators found that telehealth visits are 30% more likely to occur in states with at least some kind of coverage or payment parity laws compared to states with no telehealth parity laws during that time. The authors suggest that this is due to lack of reimbursement being a significant barrier to telehealth entry for many healthcare providers.
Kaiser Family Foundation: Back to School amidst the New Normal: Ongoing Effects of the Coronavirus Pandemic on Children’s Health and Well-Being (8/13) – KFF published a new research brief examining how COVID-19 has affected the health and well-being of children. Among the key findings, children’s utilization of telemedicine services increased since the start of the pandemic, however, not enough to offset the decrease in service utilization overall, suggesting areas where children are still experiencing delays and barriers in accessing health care. Preliminary data suggest that telehealth utilization for Medicaid/CHIP beneficiaries under 19 increased rapidly in April 2020 and remains higher than before the pandemic. While telehealth utilization has increased, the increase has not offset the decreases in service utilization overall, and barriers to accessing health care via telehealth may remain, especially for low-income patients or patients in rural areas.
1 in 5 patient visits covered by BCBSM as of March 2021 are by telehealth, showing the lasting interest in virtual visits even as the pandemic ebbed
91% of larger primary care practices in Michigan used telehealth, compared with 63% of solo practices. Larger practices also had a higher percentage of visits via telehealth.
Striking disparities in use of video visits emerged from the analysis of Michigan Medicine data, with much lower use by patients who are older, are African-American, need an interpreter, have Medicaid as a primary insurance, or live in a zip code where less than half of households have broadband Internet access.
Telephone-based audio-only visits have been covered by most insurers during the pandemic, but there are signs this may change once the emergency status is lifted. However, more than 60% of Michigan Medicine patients over age 65 used this option in May through June of 2020, with the percentage going up with age. Patients of any age who live in rural areas are also more likely to use audio-only visits.
When all costs are taken into account, video visits and in-person visits cost approximately the same, and patients were no more likely to cancel or fail to show up for a video visit than they were for in-person visits.
Half of all Michigan Medicine clinicians surveyed say that after the pandemic they intend to offer the same volume of video visits as now. About 40% said their productivity is the same now that telehealth is an option, and 27% say it’s higher. A majority said they were able to provide the same quality of care over telehealth and establish the same level of rapport with patients.
Centers for Disease Control and Prevention: Household Pulse Survey: (8/10) – According to the latest data from the latest data from the Census Bureau’s Household Pulse “near real-time” survey in partnership with HHS, telehealth usage dropped at the end of July and beginning of August, yet remains significantly above pre-pandemic levels.
FAIR Health: Monthly Telehealth Regional Tracker (8/9) – After three months of decline, telehealth utilization stabilized in May 2021, according
to FAIR Health's Monthly Telehealth Regional Tracker. Telehealth utilization, measured as a percentage of all medical claim lines, rose 2 percent nationally from April to May 2021, increasing from 4.9 percent of medical claim lines in April to 5 percent in May. By comparison, telehealth claim lines fell nationally as a percentage of medical claim lines each month from February to April. The data represent the privately insured population, including Medicare Advantage and excluding Medicare Fee-for-Service and Medicaid.
Telemedicine and e-Health Journal: A Telehealth Initiative to Overcome Health Care Barriers for People Experiencing Homelessness (7/23) – A new study examined the use of telehealth to provide care for people experiencing homelessness. Several barriers limit access to care for the homeless population, such as high costs of care, transportation access, and lack of health insurance. Results from the patient and provider surveys support the use of telehealth to improve access. With regard to technology access, more than half (50.8%) had access to a mobile phone, 71.4% to a computer, and 77.8% to the internet. The study concluded that telehealth is a feasible and potentially cost-effective method to increase access to health care and reduce health outcome disparities in people experiencing homelessness.
State Telehealth News and Activity
Public News Service: OH to Expand Interstate Health-Care Access through Nurse Compact (8/12) – Ohio Governor Mike DeWine signed Senate Bill 3 last month, which allows Ohio to enter into the Nurse Licensure Compact (NLC), a multistate agreement which allows nurses to practice in other NLC states by streamlining licensing requirements. This will make it easier for patients in Ohio to access quality health care from Registered Nurses and Licensure Practical Nurses across state lines. Ohio will officially join the NLC in January 2023 to allow time for the Ohio Board of Nursing to adapt its procedures to join the compact.
NJ Spotlight News: NJ looks to grow telehealth, a boon to patients in pandemic (8/11) – Telehealth was a lifeline for many patients in the State of New Jersey throughout the pandemic, with a recent survey by the Mental Health Association of New Jersey finding that eight out of 10 people who received virtual mental health services considered them a “great alternative” when in-person services were unavailable, as one example. To ensure telehealth options continue to grow, state lawmakers approved a measure to require insurance companies to cover the cost of virtual visits at the same rate they would pay for in-person services, including for policies covering public workers and NJ FamilyCare, the state’s Medicaid program. This legislation, which is now awaiting signature by Governor Murphy, would update a long-debated law adopted in 2017 that defined telemedicine in New Jersey and established strict requirements on how and when it could be used, in addition to provider payment rates for such services.
NCSL: The Telehealth Explainer Series: A Toolkit for State Legislators – NCSL developed a toolkit containing a series of briefs covering key topics, opportunities, and challenges related to telehealth policy. The briefs provide an overview and introduction to state telehealth roles and includes a variety of state legislative actions on several key policy areas. One section of note is the “Telehealth, COVID-19, and Looking Ahead” section, which outlines how all 50 states, DC and Puerto Rico modified telehealth policies in response to COVID, and an overview of which states are considering making such changes permanent. At least 37 states enacted over 51 bills to make certain temporary flexibilities permanent after the COVID-19 public health emergency, and some states have taken non-legislative action to make COVID-related changes permanent, whether through the governor’s office, Medicaid agencies, licensing boards, or other state agencies.
Telehealth News and Market Developments
Modern Healthcare: Digital health can help screen test for COVID-19 (8/13) – A project funded by the National Institutes of Health will soon roll out a digital health tool to provide screening and testing for COVID-19. Vibrent’s COVID-CARE program is an algorithm-based digital tool that will determine likelihood of the user having COVID-19. The data collected from the tool will then be shared with public and government sources.
Fierce Healthcare: Amwell expects fewer telehealth visits in fall, winter as delta variant creates uncertainty (8/12) – As the delta variant continues to drive the nation's latest coronavirus surge, Amwell expects fewer telehealth visits through the fall and winter. The company is projecting an $8 million impact on its 2021 revenue as a result of the drop in projected virtual care visits. The company now projects 200,000 fewer telehealth visits in the second half of 2021 as masking and social distancing measures better protect people from the typical flu season, which would drive more virtual urgent care visits.
Modern Healthcare: CVS Health launches virtual primary care for Aetna members (8/11) – CVS Health has launched Aetna Virtual Primary Care, which will provide policyholders under self-funded employer plans virtual access to a panel of board-certified physicians, a care coordination team, a virtual nurse care team and access to services such as mental health counseling, dermatology and 24-hour urgent care.
mHealth Intelligence: Is Telehealth Giving the Independent Practice New Hope for the Future? (8/10) – Independent medical practices are emerging from the chaos of the pandemic on stronger footing partially due to telehealth. A new report from Kareo finds that more than half the practices saw patient visits stay the same or grow in 2020, and three-quarters expect to see growth in 2021. In the meantime, the telehealth adoption rate among practices jumped from 22 percent in 2019 to 41 percent in 2020 to 80 percent at the end of that year. While much of the growth can be attributed to the adoption of connected health platforms and tools to make up for the loss of in-person traffic, experts say these practices now have the confidence to plan a long-term telehealth strategy that combines the two.
Harvard Business Review: A Simple Way to Identify Patients Who Need Tech Support for Telemedicine (8/10) – A new tool developed by Johns Hopkins automatically identifies patients likely to need technical assistance with their video telehealth visit, so either someone from a centralized IT support team or a member of the clinical support or front desk teams can reach out to them before their visit. The score ranges from 0 to 4, with 0 representing the lowest risk that a video visit would be unsuccessful and 4 representing the highest risk it would be.
mHealth Intelligence: UPMC Expands Telehealth Network to Offer Access to Pediatric Specialists (8/10) – UPMC is expanding its telehealth network to offer more access to pediatric specialists. The Pittsburgh-based health system announced that it’s now offering virtual care appointments for families in central Pennsylvania with UPMC Children’s Hospital of Pittsburgh, which features more than 400 physicians across 33 specialties.
Home Health Care News: Home Health Telehealth Utilization Likely to Remain Strong (8/10) – At first, one of the largest home health and hospice providers in the nation, the Dallas-based AccentCare thought there would be some difficulties getting patients to embrace telehealth, however, that did not end up being the case. “Whether they were seeing their primary care [doctors], their specialists or others, they were using similar types of technology, said Dave Davis, chief clinical innovation officer at AccentCare. “Many of them got very accustomed to it, very used to it,” he added. “Their caregivers got very accustomed to it.” The big takeaway: Patients in the hybrid model had significantly fewer hospitalizations in both 30-day and 60-day time periods. Patients in the hybrid model also showed substantially more improvement across a variety of measures, including medication management, ambulation and pain mitigation.
Fierce Healthcare: Salesforce rolls out cloud-based remote monitoring, patient access tools (8/10) – Salesforce has rolled out updates to its Health Cloud that enable providers to reach patients where they are. The new tools, announced in conjunction with the Healthcare Information and Management Systems Society (HIMSS) Global Conference this week in Las Vegas, include cloud-based remote patient monitoring to allow patients to use connected devices and technology to gather patient-generated health data and send it to healthcare professionals. Providers can then see the data within a single dashboard to better monitor patients' health conditions from home.