ThinkSet Update: Telemedicine in a Pandemic

Will the COVID-19 pandemic change the way health insurers reimburse for telemedicine? It already has.

In March 2019, JoAnna Younts wrote that widespread adoption of telemedicine would require health insurers to rethink how they reimbursed for remote-care services. In the throes of the COVID-19 pandemic, with the need to embrace telehealth taking on new urgency, she checks in on health plans’ progress.

Faced with an unprecedented public-health crisis, many health insurers are quickly shifting the ways they reimburse for telehealth services—to help not only those who have or might have contracted the COVID-19 virus, but also plan members who require other health services but can’t visit a doctor under shelter-in-place orders.

Health insurers’ fast action mirrors similarly aggressive moves by the government. On March 16, the Trump administration expanded access to telehealth services to all Medicare patients (it had previously been available in rural areas only and had other place-of-service restrictions). The federal government and several states have relaxed licensing rules to allow providers to deliver telemedicine across state lines. And on March 30, the Centers for Medicare & Medicaid Services lifted its ban on audio-only telehealth services.

Informal polling of four commercial health plan clients reveals plans expanding telehealth coverage for potential COVID-19 patients and extending telehealth access to include services like lactation consultations, speech therapy and mental health visits. Some plans are rolling out new rules around reimbursement, aimed at educating providers on how to code and bill for telehealth services. Some have modified their requirements, such as allowing audio-only visits to be billed and paid using traditional evaluation and management codes.

The data is anecdotal but representative—and the extensions of telemedicine driven by COVID-19 will likely persist well after the crisis is over, leading to a permanent and significant expansion. The need for remote medical service will likely drive millions of consumers to download telehealth applications on their computers and phones, and encourage providers to work together to include telehealth in the protocols they use to manage patients.

Importantly, the sudden, overwhelming need for telehealth services created by the pandemic is also allowing health plans to accommodate providers’ use of telehealth as a tool for patient engagement and modify reimbursement approaches accordingly.

These changes are signs of how seriously the health insurance industry is taking the COVID-19 crisis—and of how drastically the crisis could change American healthcare.