Tag Archives: telehealth

Treating behavioral health conditions through telehealth is becoming the “new normal”

The COVID-19 pandemic has created significant mental health challenges for many around the world, both directly due to the consequences of the disease, and indirectly due to the difficult circumstances that arise from mitigation strategies.

During the pandemic, the gap in care for mental illnesses and substance use disorders has been magnified by the reduction in face-to-face office visits for treatment resulting from restrictions on elective care visits, physical distancing guidelines, and the fear of spreading or contracting the disease. This challenge is being addressed by some insurers and providers through rapidly increasing use of telehealth tools to provide treatment for mental illnesses and substance use disorders.

In this article, Milliman’s Steve Melek, Stoddard Davenport, and Travis Gray explain why telehealth visits may become part of the “new normal” for replacing, or at least supplementing, office visit-based treatment for behavioral health conditions.

Critical Point explores telehealth services in the time of COVID-19

The COVID-19 pandemic has dramatically increased the use of telehealth. In this episode of Critical Point, Milliman’s Susan Philip and Mei Kwong, executive director of the Center for Connected Health Policy, talk about what the rise of telehealth could mean for the future of healthcare in the United States. They also discuss what providers, payers, and patients should know about this virtual healthcare service.

To listen to more episodes of Critical Point, click here.

Telehealth expansion aiding healthcare system during coronavirus pandemic

On a nationwide basis, we are being encouraged to limit our social interactions to slow the spread of the coronavirus, slow the rate of those who will fall ill to it, and avoid overtaxing our healthcare system over a short period of time.

What does social distancing mean for those who require healthcare during this time? Could they be helped by telehealth, which has the potential to replace some in-person services and better triage care based on needs?

Medicare has specific definitions for telehealth services—it is covered by Part B and is limited to live audio/video services furnished by specific practitioners at a distant site to a beneficiary in an originating site. Restrictions under the Medicare program regarding beneficiary location, provider type, and geography have limited the adoption of telehealth services provided to Medicare beneficiaries. The Telehealth Services During Certain Emergency Periods Act of 2020, which is part of the Coronavirus Preparedness and Response Supplemental Appropriations Act of 2020, has removed many of these restrictions.

In this article, Milliman’s Susan Philip and Susan Pantely discuss Medicare’s telehealth expansion during the coronavirus pandemic.

Critical Point podcast: A primer on telehealth in the United States

NASA developed the first form of telemedicine to monitor astronauts in space over 50 years ago. Today, telehealth is being used to deliver healthcare in the United States to a population that might otherwise have difficulty accessing care. In this episode of Critical Point, Milliman’s Susan Philip provides a primer on telehealth including its uses, regulatory landscape, and efficacy. She also discusses some of the groundbreaking new devices using telehealth to deliver care.

To listen to this episode of Critical Point, click here.




Two proposed rules open up opportunities for care coordination through telehealth

Over the summer, the Centers for Medicare and Medicaid Services (CMS) issued two proposed rules that will create mechanisms for some providers to receive payment for telehealth as well as other non-face-to-face and care coordination services using telecommunications technologies. Together, the changes proposed in the calendar year 2019 Medicare Physician Fee Schedule (PFS) and the Medicare Shared Savings Program (MSSP) proposed rules have the potential to enable new interactions that strengthen care access and coordination for a much broader set of patients.

The term “telehealth” is often used to broadly refer to the use of telecommunication technologies to furnish healthcare services. However, Medicare telehealth services specifically refer to a set of Part B-covered services specified under section 1834(m) of the Social Security Act. By law, Medicare fee-for-service (FFS) telehealth services under the PFS are currently subject to the following conditions:

• Provided using real-time, interactive audio and video
• Geographic restrictions on originating site (beneficiary location)
• Setting restrictions on distant site (provider location)
• Provider restrictions (and possibly further limitations due to state licensure laws)
• Limitations on type of visits

Waivers of Medicare telehealth rules are currently available under specific CMS Center for Medicare and Medicaid Innovation models. For example, under the existing Next Generation ACO Model, CMS has waived the geographic and originating site requirements for Medicare telehealth services. In addition, beginning in 2018, the Next Generation ACO Telehealth Waiver was expanded to include asynchronous telehealth services for teledermatology and teleophthalmology, which provides physician payment for the receipt and analysis of remote, asynchronous images for dermatologic and/or ophthalmologic evaluation.

MSSP accountable care organizations (ACOs) do not currently have such flexibility because no telehealth waivers are available to them. However, under the MSSP proposed rule, for 2020, CMS has proposed changes for telehealth services provided by ACOs that take on two-sided risk. Specifically, CMS proposes to expand the use of telehealth by ACOs by removing the geographic and originating site restrictions on these services. This means that ACOs will be able to provide telehealth services to beneficiaries in their homes as well as for beneficiaries obtaining care in metropolitan statistical areas (MSAs).

In addition, under the PFS proposed rule, CMS proposes to provide separate payment for new non-face-to-face services, virtual check-in visits, chronic care remote physiologic monitoring, interprofessional consultation, and remote professional evaluation of patient-transmitted information.

In this paper, Milliman’s Susan Philip, Carol Bazell, and Laurie Lingefelt describe these changes in greater detail and also discuss the possible implications for providers and MSSP ACOs in particular.




What are the benefits of teledentistry for the dental industry to consider?

Telehealth services come in many different forms, such as live videoconferencing or other real-time interactions, store-and-forward transmissions in which information is electronically transmitted to a practitioner who evaluates cases at a later time, remote patient monitoring by providers not in the patient’s location, and services using mobile communications devices.

Telehealth and teledentistry in particular provide a value proposition for many stakeholders within the dental industry. Teledentistry can aid in reducing dental claim costs, provide opportunities to grow individual practices, expand services to the underserved, and aid in the management of patients with chronic conditions.

For 2018, the American Dental Association (ADA) has added two teledentistry procedure codes: D9995 for synchronous teledentistry in which there is real-time interaction, and D9996 for asynchronous teledentistry in which recorded health information is sent to a practitioner to evaluate outside of real-time interaction. The ADA’s guides to using these codes indicated that teledentistry should not be thought of as a procedure but rather as a way to deliver services that treat, monitor, or otherwise engage patients.

In this article, Milliman’s Joanne Fontana and Donna Wix explore the value proposition that teledentistry could provide to dental plans, dental providers, disease management programs, and populations lacking adequate oral healthcare. They conducted a literature search on teledentistry innovations and used Milliman’s internal data sources to assess the cost impact of such products and services.