Health insurers are increasingly looking to telemedicine to ease provider shortages, expand access to care, increase patient satisfaction and lower costs. With advances in data sharing, payers and telehealth companies are also making strides in managing patient populations to improve outcomes.
Teladoc, the nation’s largest telehealth provider, is currently working with 28 health plans, including Aetna, Oscar and Blue Shield of California. Others, like RelayHealth and Cirrus MD, are also partnering with insurers.
Sharing gaps-in-care data identified through claims data with telehealth providers can help to improve health and outcomes, says Nirmal Patel, CMO at Teladoc, the nation’s largest telemedicine provider. The Dallas-based firm has invested in technology to ensure flow of information between its virtual providers and a patient’s physical doctors and health plan.
Today, 48 states and the District of Columbia provide some form of Medicaid payment for telehealth services, according to the National Conference of State Legislatures. Thirty-two states and D.C. offer some kind of private insurance policy.
In addition, 29 states and D.C. have telemedicine parity laws for private payers, 22 of which earned a Grade A, indicating no provider or technology restrictions, a recent report by the American Telemedicine Association shows. Connecticut and Rhode Island ranked the lowest with failing grades in Medicaid parity and restrictions to private payer telehealth services.
The types of telehealth providers being covered by Medicaid is also expanding, with 17 states and D.C. not limiting payment to certain types of providers, the report notes. Still, 20 states authorize less than nine provider types, and Florida, Idaho, and Montana cover only physicians.
Aetna began offering Teladoc in 2011 as a pilot to fully insured members in Florida and Texas, expanding the following year to self-funded plan sponsors, seven of which implemented the program, says Aetna spokeswoman Sherry Sanderford. Today, more than 700 self-funded plan sponsors have implemented Teladoc, providing access to more than 6 million fully insured and self-insured members.
Sanderford says the company continues to explore ways to expand coverage of telemedicine services. In 2012, for example, Aetna revised its payment policy to allow reimbursement for certain telemedicine codes within specific contracts such as accountable care arrangements, Level III NCQA Recognized Patient Centered Medical Home physicians and where state regulations apply.
“This policy change allowed doctors to be more accessible, offering ‘virtual’ care after hours and accentuating the patient-centered nature of high-quality care,” Sanderford says. Aetna is currently working with Teladoc to add behavioral health services.
Cigna began offering reimbursable “virtual house calls” in 2007 via RelayHealth, which offers consultations using an online, structured interview format to routine, nonurgent health concerns to an individual’s plan-contracted physician, says Robert Wijnhoven, marketing product manager for telemedicine at Cigna. More recently, the payer paired with MDLive to provide year-round, 24/7 online video and telephone consultations with board-certified internal medicine, family practice and pediatric physicians.
Both models are available through Cigna’s employer-sponsored administrative services only health plans, which comprise about 80% of Cigna’s health plans.
“From a dollars and cents perspective, our telemedicine partners provide a lower-cost alternative to traditional forms of care,” Wijnhoven says. “The weighted average cost savings for a customer choosing telemedicine over other care approaches (office visit, urgent care, ER for nonemergency situations) is $124 per episode of care,” he wrote in an email. “When the productivity value is factored in (e.g. savings from not losing time making the appointment, driving, filling out forms and waiting to see the doctor), the total average benefit of choosing telemedicine is $164.”
Partnering with telehealth companies also aids in population health management by improving care quality, access, affordability and continuity, says Wijnhoven.
Cigna teams with telehealth vendors that either contract with the payer’s nationwide network of board-certified physicians or use their own, ensuring evidence-based best practice. And by letting patients share their virtual results with their primary care physician, the collaboration enhances continuity of care and outcomes, Wijnhoven says.
Andrew Altorfer, CEO of CirrusMD agrees. The Denver-based telehealth firm has partnered with Rocky Mountain Health Plans (RMHP) to provide access board-certified physicians 365 days a year, helping to avoid unnecessary emergency care trips. Using the HIPAA-compliant MyDigitalMD platform, patients can schedule video visits and text message with providers via smartphone, tablet or computer. The platform also allows for image sharing.
In addition to commercially insured patients, the arrangement covers about 140,000 Medicaid patients in 22 rural counties in Colorado.
The program provides full continuity of care for the Medicaid population, says Altorfer. When one of the doctors staffing the virtual service has a patient encounter, a recap of that encounter is routed into an EMR and also funneled via a health information exchange to the patient’s primary care provider and care manager,” he tells Healthcare Dive.
The service has been a win-win for the firm and RMHP. Roughly 13% of total visits were diverted from the ER, 30% from urgent care and 32% from a primary care office visit, resulting in a $435 savings per encounter. Just 2% of patients went to the ER and 2% to urgent care following a virtual visit.
Moreover, 85% of encounters were handled via text messaging, an approach that Altorfer says is particularly useful in a Medicaid population. “Messaging is very unique, in thinking about managing a population, because it’s a continuous pathway of access,” he explains
By promoting a messaging-first workflow, patients can continue to engage with providers to manage their health over a period of time, be it minutes, hours or a few days, Altorfer adds. “We’ve actually seen encounters play out over the course of a week where someone’s traveling and one of our physicians is helping them manage” a condition.