January 23, 2020
Federal and state laws and regulations affect the availability of telehealth services, who can provide them, the conditions under which providers can offer them, and the cost of provision of these services. Provider licensure laws, facility requirements, the scope of services approved for telehealth, and payment regulations impact the availability and cost of care provided virtually. Similarly, the approach that federal programs like Medicare, Medicaid, and the Veteran’s Health Administration (VA) take toward telehealth influences the private market for telehealth services. Unnecessarily restrictive state laws and regulation, and variations among states, make it more difficult and costly for employers to offer telehealth services to employees and their families. Of particular concern are state payment parity mandates, which require that patients and plans pay amounts equivalent to in-person visits for care provided virtually.
Though telehealth services had been widely offered prior to the pandemic, with 98% of large employers responding to our 2020 Health Care Strategy and Plan Design Survey already having virtual care options for primary and acute care in place in 2019, for example, utilization has experienced a manifold increase in response to the COVID-19. While the dramatic increase in utilization is in part due to the safety of virtual care during the pandemic, temporary policy changes in Medicare rules, legislation that makes it easier to provide care virtually for people in HSA plans and state relaxation of restrictions have contributed to an accelerated expansion of telehealth during the pandemic. For example, by April 2020, nearly half of all Medicare primary care visits were by telehealth (HHS ASPE, 2020), which is consistent with private sector surveys of consumers for all types of health care visits since the pandemic began (McKinsey, 2020).
While these temporary changes have encouraged people to get needed care safely and conveniently during the pandemic, and employers generally support eliminating unnecessary policy barriers to effective use of telehealth, it is important to evaluate the quality, appropriateness, patient experience, health inequities and cost impacts in order to assess its overall value as policymakers debate whether or not to make these temporary policy changes permanent.
Federal and state policies should foster growth of telehealth services that promise to improve the value of health care delivery. Business Group on Health recommends that policymakers do the following:
- Permanently relax the rules for coverage of telehealth and other remote services prior to meeting the HSA deductible, giving plans the option to waive them, and for people to receive these services at little to no cost sharing without jeopardize the tax-favored status of their HSA contributions.
- Ensure that telehealth providers follow all applicable state and federal privacy and information security rules/laws. Do not make permanent the temporary relaxation of HIPAA privacy, security, and breach notification rules under emergency powers authority during the COVID-19 public health emergency.
- Oppose telehealth payment mandates including those that would require parity in payment for services provided via telehealth as those in person or those that would impede employers’ flexibility for innovative, value-based payments.
- Evaluate the performance and value of telehealth prior to making permanent any of the other temporary changes and relaxation of rules during the pandemic. Factors to evaluate include its impact on quality (including its overall integration into care), safety, appropriateness (both medical necessity of the care itself and its provision virtually rather than in-person), cost, access, patient experience, and health inequities.
- Eliminate state barriers to flexibility for employers to offer telehealth services to their populations (including access across state lines, to increase rural access, etc.)—without having to deal with different residency, provider licensure, patient-provider relationship, technology, scope of services, and other requirements.
- Cover a wide array of modalities (video conferencing, telephone and telephone-only, store and forward technologies, remote patient monitoring and mobile health technologies), where appropriate, to deliver telehealth services, including for mental health, chronic care management, primary and acute care, rehabilitation and other services.
- Recognize appropriate limits and conditions on the use of telehealth for prescribing and monitoring of the use of controlled substances and other medications where appropriate physicians’ supervision is desirable (e.g., narcotics or some mental health medications).
Why It Matters
- According to our latest survey, nearly all employers who responded will offer telehealth for some services, eight in ten respondents (80%) believe virtual health will play a significant role in how care is delivered in the future, and over half (52%) will offer more virtual care options next year.
- The explosion of virtual care due to the pandemic presents an opportunity for lasting transformation of health care delivery. However, it is imperative to evaluate the appropriateness of virtual care for various conditions and types of care (e.g., acute care, chronic care management, remote monitoring, mental health services, evaluation and management), and its impact on clinical quality and safety, access (including for services or geographies with provider shortages, rural areas, and for people with transportation and other challenges related to social determinants of health), convenience, and costs.
- In addition to potential savings from foregone downstream care, better remote monitoring of people with chronic conditions, and better access to virtual mental health counseling, a recent study found per visit savings between $19-$121 based on analysis of 650 patients using a health system-based telehealth platform.