As Managed Care Embraces Telehealth, Medicare Slower to Change

Concern from Congress about the potential cost of widespread use has kept telehealth from expanding in traditional Medicare. But things are starting to change as ACOs gain the ability to use telehealth, and rule changes allow its use for mental health and other services.
Published Online: June 23, 2015
Mary K. Caffrey
Both Aetna and UnitedHealthcare pay for telehealth services. Large employers are increasingly adding the benefit, making it easier for staff to get care without missing work. But Medicare, which would seem a logical place for telehealth to gain a foothold, has been slower to act.

The concern of the Congressional Budget Office, as reported by Kaiser Health News, is the potential cost. The fear is that if telehealth were widely available, it would be so convenient it would be overused.

So far, telehealth is a pittance in the overall Medicare budget—just $ 5 million out of $466 billion in 2012—but that’s starting to change.

Medicare Advantage plans can use telehealth because the cost is embedded in the per capita payment, and accountable care organizations (ACOs), which are groups of hospitals and providers that manage health of populations, have more recently gained the ability to try telehealth following a recent rule change.

As Krista Drobac, executive director of the Alliance for Connected Care wrote in The American Journal of Accountable Care last year, making telehealth available to seniors just makes sense.

 Evidence shows that telehealth promotes quality care, holds down costs, prevents unnecessary inpatient admissions, and increases access to timely primary care, she wrote, adding, “Telehealth also allows providers to connect patients with appropriate specialists and coordinate care across clinical settings.”

Experts told Kaiser Health News that it’s disappointing that traditional Medicare restricts the use of telehealth, because seniors as a group would benefit greatly from expanded use. Follow-up appointments are frequently missed because of lack of transportation.

Drobac, in speaking to a gathering of the ACO and Emerging Healthcare Coalition in Miami in October 2014, said those who have tried telehealth give it positive reviews. (The ACO Coalition is an initiative of The American Journal of Managed Care.)

The need for telehealth is great as the population ages but continues to work, making schedules busier than ever, she said. The shortage of primary care physicians adds to the need. At the same time, she told the group, opportunities for telehealth will expand with the rise of wearable technology.

Bit by bit, use of telehealth is expanding. It is now permitted for mental health services, wellness visits, as well as certain rural settings and in some clinics.

What’s clear is that consumers want to see telehealth grow. The American Association for Retired Persons is pressing Congress for broader use, and both the American Medical Association and the American Academy of Family Physicians are on board as well. Having doctors’ groups embrace expansion is key, because in the past, opposition from state-level professional groups kept telehealth from moving forward.

At the ACO meeting, Drobac said in the past, some primary care physicians saw telehealth as a threat, but more recent reports suggest that is changing. Mia Finkelston, a Maryland physician, told Kaiser Health News that doctors know when they can handle issues remotely and when they need to tell patients to see a doctor in person or go to the emergency room.

“Our intent is not to replace their primary care physician, but to augment their care,” she said.
 



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