Payers and providers confirm COVID-19 is accelerating telemedicine plans

Telemedicine is finally having its moment. It’s long been viewed as a potential way to reduce healthcare costs and drive better coverage among underserved areas, but utilization hasn’t kept pace with expectations. According to Peterson-KFF Health System Tracker, in 2018, 2.4% of large group enrollees who had an outpatient office visit had at least one telemedicine visit, which was up from 1.6% in 2017.

But then came COVID-19, and for many patients, a virtual visit was the only option they had to see a physician. Suddenly, the healthcare industry shifted from face-to-face to almost exclusively telemedicine.       

To understand what it’s been like, Availity hosted our first Availity Connects: COVID Roundtable. During this virtual session, more than 20 participants from both health plan and provider organizations discussed the rapid transition to telemedicine, and what health plans and providers might expect going forward.

Adjusting to telemedicine

Several health plan attendees acknowledged that their organizations had been on a path to expanding telemedicine, but COVID has accelerated the trajectory and forced them to act quickly to address the demand. “While telemedicine was already in many fully insured products,” said one representative, “we needed to get decisions from Administrative Services Only (ASO) clients on how they wanted to handle telehealth services because they didn’t have it in their products.”   

For provider organizations, the transition to telemedicine was also dramatic. The director of revenue cycle for one hospital system said that the roughly 3,000 providers in his organization went from doing nothing with telemedicine to doing it exclusively. Pre-COVID, most of these physicians had been resistant to telemedicine, but now there’s a much more pragmatic attitude. “It’s forced us to recognize that this is a viable way to practice medicine,” he said.

But health plan representatives were cautious about predicting how telemedicine would be integrated into their products going forward. Many of the initiatives that were quickly put in place to help providers transition to telemedicine needed to be assessed, and all health plans are keeping a close eye on regulatory changes. “We see the benefits of virtual with customer experience and out-of-pocket costs,” said one health plan attendee, “but what that means in a post-pandemic setting is yet to be determined.”  

Both sides felt things were largely going well with telemedicine, and one provider representative thanked the health plans for their constant communication. But there were also some potential issues identified. Provider representatives expressed concern that payers might not accept prior authorizations for procedures if the evaluation had been done virtually. And one health plan said that they have seen some coding anomalies that needed further investigation.

But roundtable attendees largely agreed that telemedicine would be a significant part of the healthcare mix going forward. Provider organizations see an opportunity to expand services beyond their geographic footprint. One provider representative noted that his organization’s downtown setting was often a barrier for patients in the suburbs, and telemedicine could offer a more convenient way for these patients to see specialists. Health plans have long looked for ways to better serve rural communities, and telemedicine could address that gap if they could drive adoption among patients. As one health plan attendee noted, “With the right situation and setting, we’ll see more patients and providers using it.”

Next Roundtable: Medical Attachments

As health plans and provider organizations move to remote operations, one of their biggest challenges continues to be paper-based processes, which require some staff to be onsite. In the second Summit Roundtable, we’ll take a deep dive into electronic attachments.