Telehealth: healthcare's new normal beyond COVID-19

By Victor A. Oliva

Telehealth: healthcare's new normal beyond COVID-19

BlueCross BlueShield of Tennessee (BCBSTN) has recently announced that its coverage of telehealth services will now be permanent, marking a clear shift from industry norms. Due to COVID-19, other private insurers have only temporarily expanded their coverage of telehealth services, implying this expansion only reflects current circumstances and not an advancement in coverage. However, BCBSTN’s move to make this coverage permanent signifies the beginning of an industry trend in the validation of telehealth services and a willingness to embrace its utility.

Where Have We Been and Where Are We Now?

The passing of the Telemedicine Communications Act of 1996 and the Balanced Budget Act of 1997 allowed for payment of professional telemedicine consultation in 1999, enabling both public and private payers to reimburse for telehealth services. Telehealth has since had a slow introduction into the healthcare industry as providers have been reluctant to break from routine and integrate new technology into their workflows. Prior to the COVID-19 Pandemic, Medicare provided coverage for telehealth services, but placed limits on what providers could be reimbursed for based on the location of the patient relative to the provider and what services were provided. Medicaid reimbursements varied state-by-state with some states going so far as to mandate that even private payers reimburse for telehealth services. Outside of state mandates, however, private insurers varied greatly on what telehealth services they reimbursed for.

Now, the Coronavirus Preparedness and Response Supplemental Appropriations Act has allowed for Medicare to expand its coverage of telehealth services, with states enacting similar expansions through Medicaid. Private insurers followed suit and temporarily expanded their coverage of telehealth services, with BCBSTN being among the first to make this permanent due to how seamlessly telehealth has been integrated into preventative, routine, and maintenance care.

 The Value of Telehealth

During COVID-19, the value of telehealth has become increasingly recognized as people have sought to avoid public places and healthcare facilities utilized e-triage to promote safety and reduce strain on the system. To put it simply, telehealth has always been a valuable component of healthcare, necessitating a need to promote its adoption through incentives and permanent policy changes. Post-pandemic, many patients will require telehealth for a number of reasons:

  • Rural communities: patients living in rural communities face with long travel times as specialty clinics are often located in larger towns and cities hours away. Telehealth enables them to save time and easily access healthcare services.
  • Elderly and at-risk patients: the current pandemic has made us aware of how vulnerable the oldest and sickest of us are, but these concerns remain outside of COVID-19. Elderly and at-risk patients can utilize telehealth to remain in their homes to protect their health and avoid unnecessary travel and exposure to a potentially dangerous hospital setting.
  • Wait-times: before COVID-19, long wait-times at hospitals were often characteristic of healthcare visits. Telehealth allows providers to more easily manage patient queues while patients wait in the comfort of their homes.
  • Pre-Appointment prep: telehealth services provide a valuable channel for patients to upload data from their medical devices, complete patient surveys, and complete other tasks that allow for a more streamlined in-person patient experience.

Telehealth Is Great, but What’s the Catch?

 Coverage for telehealth services has historically varied significantly based on insurance status and geographic location. The disparities in coverage have prevented access and widespread adoption. During this current period of increased coverage of these services, telehealth has become the standard of care in many cases given that it provides a more convenient, efficient, safer means to provide care. Despite its recent popularity, it is important to continue to break down some of the last remaining barriers, including:

  • The Digital Divide: telehealth can be conducted over phone calls, but smartphone apps and video calls over the internet are becoming increasingly more popular in conducting telehealth. Patients that have slow internet, lack a smartphone, or are unfamiliar with new technology will find difficulty in utilizing emerging telehealth services.
  • Privacy and Security: penalties for the utilization of certain HIPAA-noncompliant technology to conduct telehealth has been waived during COVID-19, but this is expected to only be in place during the pandemic. Moving forward, telehealth services will require high quality data encryption and protection in order to main the confidentiality of patient information shared through the internet.
  • Licensing: many providers have been restricted to providing telehealth services only in states that they are licensed in. However, in the wake of COVID-19, the majority of states have granted waivers for out-of-state physicians to provide telehealth services to residents. The extension of these waivers post-pandemic would allow for the establishment of telehealth as a commonplace practice.

Why Does Telehealth Work So Well For Diabetes Management and Chronic Condition Care?

Diabetes and other chronic conditions require constant interaction between patients, often at-risk and/or elderly, and healthcare providers. Telehealth enables a continuity of care that is convenient to both patients and providers without placing these more vulnerable populations at undue risk.

Specifically concerning diabetes, Continuous Glucose Monitoring (CGM) devices have provided a new avenue for diabetes management in partnership with telehealth and have shown to be cost-effective. With a need for a constant information flow between people with diabetes and endocrinologists, telehealth providers can ease this flow by helping to upload and interpret the data from these devices, resulting in streamlined endocrinologist visits.

 How Can Telehealth Companies Make an Impact?

 As a digital health platform, Cecelia Health is well equipped to support patients with chronic conditions via telehealth, especially as they navigate the challenges associated with the COVID-19 Pandemic. Our Certified Diabetes Care and Education Specialists and other expert clinicians provide one-on-one consultations that equip patients with the tools to meet their specific needs and goals. Health plans should consider following BCBSTN’s lead to permanently provide coverage telehealth services, partner with a digital health provider, and offer these services in-network. Doing so has the potential to decrease their healthcare costs and frequency of hospital admissions that arise from chronic condition complications.

Subscribe to the Cecelia Health Blog

Never miss a blog article. Sign up to receive one email per week rounding up our latest diabetes management content, industry innovation updates, and company news.

Orignially published on June 16, 2020, updated on June 18, 2020

Topic: Industry Innovation

Victor A. Oliva

About Victor A. Oliva

Victor Oliva is an MPH candidate at Columbia University Mailman School of Public Health focusing on community outreach, sexual and reproductive health, and health inequities. He has an administrative background in Alzheimer’s disease clinical research.