July 28, 2020 | InBrief

Navigating the future of telehealth while COVID-19 legislation remains uncertain

Health payer organizations understand that telehealth is here to stay. But legislative roadblocks may impact its viability and availability for customers.

COVID-19 and the CARES Act have turned telehealth from a fairly underutilized resource to a mainstream tool. Broadly speaking, telehealth has allowed healthcare providers to maintain a certain level of service continuity amid limitations to in-person visits and restrictions of elective procedures. 

For both healthcare providers and payers, it was a wake-up call that highlighted the potential value of telehealth when routine care and prevention can’t be delivered in the traditional way. This is particularly true given the eased restrictions around remote care across state lines, potential to waive or reduce cost sharing, and the expanded protections for remote communication technologies (even if those technologies are not fully HIPAA-compliant).  

In order for health payer organizations to be successful in how members are receiving care virtually, they must re-evaluate their member’s journey, how data is being leveraged to engage and activate behaviors, and existing and innovative partnerships necessary to make sure they receive the right care and information through their communication preference at the right time. Health payer organizations must realize that telehealth is here to stay and determine their readiness for the long term. 

Despite the rapid adoption of telehealth services and tactics over the past several months (more than 9 million Medicare beneficiaries have used telehealth throughout the U.S. during the pandemic, for example), current legislative roadblocks leading up to the expiration of the CARES Act on July 31 may impact telehealth’s viability and availability as a means of care delivery.   

The legislative landscape

There are currently 29 telehealth bills (both partisan and bi-partisan) in various committees, and little traction has been gained on bi-partisan legislation as the CARES Act expiration and Congress’s August recess approach (as of this publication, Senate Republicans have proposed the Health, Economic Assistance, Liability Protection and Schools (HEALS) Act, which includes the extension of telehealth flexibilities through the end of 2021 or the end of the COVID-19 public health emergency). Further confounding the situation is the degree of state-level variations in policy pertaining to reimbursement, locations, and cross-state licensing, making consistent alignment with federal guidelines an ongoing challenge that appears poised to complicate access to telehealth services. 

The latest piece of legislation introduced in the House, the “Protecting Access to Post-COVID-19 Telehealth Act of 2020,” is a bipartisan bill that authorizes the Secretary of Health and Human Services to modify/waive Medicare requirements during any emergency period, negating the need for legislative action and thereby potentially improving responsiveness. Additionally, the Telehealth Response for E-prescribing Additional Therapy services is also bipartisan and intended to increase the use of telehealth for substance use disorder treatment. These bills are admirable but nevertheless provide only piecemeal solutions.

Next steps for payers

Given this legislative landscape, we could be headed for the enactment of some form of emergency measure to prevent disruption of telehealth services. Whether this is an extension of the CARES Act or some combination of existing and new parameters, health payer organizations should be ready to innovate with provider partnerships and seize the opportunity to change engagement tactics and actively educate and support their members. This is especially true if the CARES Act is not extended and a new set of requirements and stipulations must be navigated.  

Either way, health payers that understand that telehealth is here to stay can take further action to support effective utilization of telehealth services. These actions include: 

  • Implementing oversight that includes monitoring frequency and auditing, as needed 
  • Providing members with local internet provider information and promotions or opportunities to gain broadband access or to assist with resolving existing service issues 
  • Investing in HIPAA-compliant platforms to ensure appropriate security and provide a better patient experience 
  • Addressing security/infrastructure and privacy and data concerns related to telehealth technologies and the exchange of PHI 
  • Rethinking the member journey to consider creative ways to maintain their provider relationship and receiving the right level of care 
  • Re-evaluating resource and staffing models to support the shift and activate innovation, engagement, and care support 
  • Re-imagining ways to achieve competitive differentiation through member education and engagement 
  • Simplifying and marketing access for patients that are missing care because of the pandemic

To this point, health payer organizations have an opportunity to move the needle by taking action like those outlined above, particularly when it comes to member engagement and partnerships with providers. Some organizations initially relaxed restrictions for non-ERISA plans but are now rolling back waivers and re-instituting limits, potentially missing opportunities to leverage shared risk relationships with providers to support continued use of telehealth services. There is power in the data that payers can offer providers to address gaps in care with telehealth services, driving down cost and improving overall patient outcomes and member experience in the process.  

Regardless of the legislative outcome, health payer organizations are in position to seize the telehealth opportunity through creative partnerships and enhanced member engagement.  

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