Telehealth, which is a solution to many challenges when it comes to accessing healthcare services, still has an upward climb in penetrating primary healthcare in the United States. According to recent survey results summarized in Modern Healthcare, only 15 percent of the 1,500 family physicians surveyed are using telehealth in their practices. Rather than resistance to new methods, physicians pointed to lack of payment as the top barrier to adoption of telehealth in their respective practices.
Many insurers in the United States have resisted paying for telehealth services, even as technology continues to evolve and offer higher-quality video equipment and transmission capabilities. Some insurers, such as Blue Cross and Blue Shield of Alabama, are beginning to embrace telehealth as some of their key concerns are allayed. Among those concerns are cost, definition of telehealth services, and confidence in a successful track record of telehealth adoption and effectiveness.
Cost Concerns Dwindling
Some insurers hold near-monopolies of the commercial healthcare market in many states. Overall, health insurers across the board have traditionally been slow to let untested claims about reducing cost shift their course. Recently, cost information has become more compelling. “A $50 telehealth visit to diagnose an ear infection is much cheaper than a $600 trip to an emergency department,” cited Modern Healthcare.
Definition of Telemedicine Outlined
Insurers that pay for healthcare services require a definition of the offering. Doctors need to know what constitutes a healthcare claim. For example, some wonder if every patient phone call is equal to a visit, or if there are particular primary-care treatments that should always be conducted by video or telephone, such as ear infections or colds. In the past, insurance leaders struggled to find a consistent definition of telemedicine. “People struggled to really tell us what that is,” said Doug McIntyre, vice president of network operations at BCBS of Alabama.
Over the past year, however, telemedicine has become more defined. In fact, BCBS of Alabama has begun paying providers for five telemedicine services, including behavioral health and stroke. Now, the technology used to treat patients in the five approved areas is considered “indistinguishable from a face-to-face visit,” said McIntyre.
Established Track Record of Telehealth Adoption
While telehealth offers promising solutions, such as the ability to serve elderly patients with multiple chronic conditions, insurers need to see more proof points. Recent trends indicate, however, that telehealth standards are being developed quickly at the state level. The National Conference of State Legislatures estimates 32 states will have private telehealth coverage laws in effect by 2017. Although laws will vary from state to state, the overall effect is that commercial insurers will be mandated to pay for certain telehealth services. As coverage increases, the cycle of physician and patient adoption can logically be expected to increase.
The Future of Telemedicine
Insurance industry leaders are defining and providing for telehealth services in response to what they see in the market. “With today’s modern family and professional life and the practicalities of getting to the doctor, we need to offer the access and convenience of a virtual visit,” said Michael Redeschi, director of product management at Highmark, a Blue Cross and Blue Shield affiliate in Pittsburgh.
As private insurers continue to see documented cost savings, mandates for coverage at the state level and increased adoption of telehealth services, the industry will continue to grow.