Tag Archives: telemedicine

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.




Reduce healthcare’s long-tail problem with telemedicine

Technology has enabled many industries to reduce or eliminate the long-tail problem. Similarly, telemedicine offers the healthcare industry a solution to its long-tail problem—access barriers to healthcare services. A new article entitled “Telemedicine and the long-tail problem in healthcare” by Milliman’s Jeremy Kush and Susan Philip explores the benefits of telemedicine as a mode for healthcare delivery. The authors also analyze current levels of telemedicine utilization and identify five factors limiting adoption.




Alternative payment models advancing telehealth use

Alternative payment models that incentivize value and improve population health management are a catalyst increasing telehealth’s acceptance. Employers also realize the potential cost-saving advantages of offering telehealth benefits under alternative payment models.

In her article “Telehealth under alternative payment models,” Milliman’s Susan Philip highlights some alternative payment models adopting telehealth services to improve the quality and delivery of care. In addition, she discusses how an assessment of these solutions can help organizations gauge their prospective returns on investment (ROI).

Here is an excerpt:

Cost savings and efficiency gains under alternative payment models will be driven by delivery system transformation and successful population health management initiatives. Telehealth has the potential to boost the impact of population health management initiatives while improving access and convenience of healthcare delivery.

Telehealth’s potential is not lost on investors and employers. In 2014, companies focused on telehealth technologies received about $285 million in venture capital funding, a substantial increase from less than $100 million in 2013.6 A recent employer survey indicated that about a third of employers expect to offer or are considering offering telemedicine consultations to employees as a low-cost alternative to emergency room or physician office visits for nonemergency health issues.7 The same survey found that telemedicine has the potential to deliver close to $6 billion in savings to U.S. companies.

Such high expectations must be calibrated. To conduct appropriate ROI evaluations, telehealth solutions and programs should be designed to consider the purpose of the solution. In general, we think of telehealth solutions for one of three primary purposes: improve access to specialty care, support care management, or provider nonemergency acute care services….

By design, telehealth programs intended to provide convenient access to a limited set of nonemergency, acute care services can be expected to increase the use of those services. Vendors such as Teledoc, American Well, or Doctors on Demand typically offer 24/7 video visits for common symptoms that may require consultation with an advance care practitioner or a physician. Examples include UTIs, skin issues and rashes, diarrhea and vomiting, and cold and flu symptoms such as sinusitis, or bronchitis. These services are not designed to substitute for an ongoing relationship with patients’ primary care providers but rather to provide an alternative to urgent care or ER visits for nonemergency conditions. Robust evaluations of the potential return on investment should consider whether services merely drive up total use and cost of healthcare for a given population, or whether the telehealth services successfully replace other, more costly services such as emergency care or urgent care visits.

Health insurers, purchasers, and investors will look to properly designed evaluations to assess return on investment and metrics related to utilization, costs, access, and quality of care.

For perspective on how telehealth technologies are being used within microinsurance schemes in sub-Saharan Africa and rural health clinics in California, read the article “m-Health: Remote access.”