Dive Brief:

• Mental healthcare led telehealth utilization for the sixth straight month in April, representing 68.4% of telehealth claim lines among privately insured patients, according to Fair Health’s April telehealth report.
• Although nationwide demand for telehealth services dipped by 5.4% from March to April this year, the percentage of telehealth claims related to mental health services grew for the fourth consecutive month.
• The report comes as lawmakers debate making pandemic-era telehealth flexibilities permanent after mental healthcare utilization increased during the COVID-19 pandemic.

Dive Insight:

Treatment rates for some psychiatric illnesses rose by between 10 and 20 percent during the first year of the pandemic due to increased demand and a higher supply of providers available to offer care via telehealth, according to researchers at RAND.

Interest in telehealth even extends to populations that may be less comfortable with technology, including the elderly. In 2022, a Rock Health survey of Americans found nearly 40% preferred telemedicine to in-person care for accessing mental healthcare.

Federal lawmakers have until the end of 2024 to make COVID-19 telehealth flexibilities permanent or create policy versions that would address payment parity, audio-only telehealth reimbursement and interstate licensures. 

Last month, a bipartisan group of lawmakers reintroduced the CONNECT for Health Act for a second time in Congress. The updated bill, which aims to make pandemic-era virtual care flexibilities permanent, would remove geographic restrictions on telehealth services and the six-month in-person requirement for telemental healthcare.

Though telehealth has “unbelievably widespread support,” Joe Ganley, vice president of government relations and regulatory affairs at Athenahealth, told Axios that cost is a potential hurdle. One report from the Committee for a Responsible Budget estimated that making telehealth expansions permanent could cost Medicare $25 billion over 10 years.

Dive Brief:

• Amazon announced Tuesday it had expanded its direct-to-consumer virtual care service Amazon Clinic to all 50 states and Washington, D.C., about nine months after its launch in November.
• The clinic is available 24/7 via Amazon’s website and its mobile app and connects consumers to third-party clinicians for care for common health conditions like urinary tract infections and pink eye.
• Message-based visits are now available in 34 states, while video calls are open nationwide, according to a company blog post. 

Dive Insight:

Amazon has been steadily expanding its presence in healthcare over the past several years, though not all its ambitions have panned out. 

Amazon Clinic launched only a few months after the company confirmed it would shut down Amazon Care, another virtual care business geared toward enterprise customers. The company’s joint venture with J.P. Morgan and Berkshire Hathaway aimed at lowering healthcare costs shuttered in 2021 after just three years in operation. 

But the tech and retail giant recently completed its $3.9 billion acquisition of primary care chain One Medical, and it’s been adding new features to its online pharmacy Amazon Pharmacy, like a generic drug subscription service and a tool that automatically adds manufacturer coupons for some drugs. 

Last month, the tech giant also announced an Amazon Web Services tool called HealthScribe that allows providers to build applications that use speech recognition and generative artificial intelligence to document patient visits, bringing the company into the increasingly competitive space for AI-backed clinical notetaking tools. 

Amazon pitches its latest virtual care venture as an “affordable and convenient” service for more than 30 common health conditions, including concerns like sinus infections, skin conditions, asthma and reproductive care.

Amazon Clinic contracts with telehealth companies Wheel, SteadyMD, Curai Health and Hello Alpha to power the service. Though expenses can vary depending on telehealth provider and treatment, message-based visits usually cost $35, while video consultations run $75. 

“We’re excited to bring Amazon Clinic to even more customers, and we’re working hard to make even more conditions available for treatment in the coming months,” Nworah Ayogu, chief medical officer and general manager of Amazon Clinic, wrote in a blog post. 

Amazon Clinic’s nationwide expansion was delayed after lawmakers raised concerns about patient privacy earlier this year, according to Politico.

Senators Peter Welch, D-Vt., and Elizabeth Warren, D-Mass., sent a letter to Amazon CEO Andy Jassy asking the company how it collects and uses data from Amazon Clinic customers, after the Washington Post reported about an authorization form for “use and disclosure of protected health information.”

An Amazon spokesperson denied that there was any external reason behind the delay at the time.

On its blog post announcing the expansion, the company said it asks for a HIPAA authorization to “make things easier for customers” and ensure clinicians can “provide continuity of care.”

Sponsored content

By CHG Healthcare Services

Telehealth can be a valuable option for patient care. Not only is it popular — preferred for its convenience by 69% of Americans¹— it can be cost-effective as well. 

When offered as an alternative to in-person care, telehealth should be supported and staffed appropriately. To help your organization achieve its telehealth-related goals and navigate the latest rules and regulations, consider the following five essentials. 

1. Licensing and credentialing for telehealth 

Federal and state laws require providers delivering care to be licensed in the state from which they’re delivering care (the “distant site”) and the state where the patient is located (the “originating site”). 

Fortunately, most states have cross-state licensing, which include telehealth-specific exceptions that allow providers to offer care in a different state if certain conditions are met. 

To deliver telehealth services, a provider must be credentialed for and have privileges at the facility they will be working for, regardless of whether they’re physically on-site. This can be done by a traditional in-house credentialing process or through credentialing by proxy. This is true for both rural and urban locations. 

2. Telehealth reimbursements 

Reimbursement rates for telehealth services vary by payor and may differ if you’re receiving payment from a private payor, Medicare, or a state Medicaid plan. 

Some reimbursements may be subject to locale parity laws. There are two types of pay parity: 

• Payment parity, where visits are reimbursed at the same payment rate or amount as if care had been delivered in person.  

• Service (or coverage) parity, where parity requires the same services be covered for telehealth as they would be if delivered in person. 

Parity laws vary by state and are subject to change. For the most up-to-date information, visit www.cchpca.org.  

3. Billing for telehealth 

The billing process for telehealth claims varies by payor. Many states have active legislative efforts to reevaluate telehealth reimbursement policies, both for private payors and CMS services. 

• Medicare. With this expansion of telehealth care in 2020, Medicare patients were able to receive virtual treatment for a wider range of services from more types of providers. However, some telehealth reimbursements are set to expire at the end of 2023.  

• Medicaid. Medicaid has both coverage and payment parity laws in place in all 50 states and the District of Columbia. 

• Private insurance. Each private insurer has its own process for billing for telehealth, but most states have laws in place that require private payors to reimburse for telemedicine visits as well as in-person care. 

4. Telehealth technology 

Many healthcare facilities use the telehealth capability built into their electronic health record (EHR) system. However, other HIPAA compliant technologies can be used for telehealth visits as well. Ask the following key questions before implementing a telehealth technology provider: 

• Is your technology HIPAA compliant? 

• Can visits be scheduled through the platform? 

• Does it require patients to download and install an app? 

• Can patients complete any necessary forms through the platform? 

• Can patients upload photos or attachments through the platform? 

• How does it integrate into my EHR? 

For tips on telehealth technology implementation, see the Health Resources and Services Administration’s guide: Getting started with telehealth (https://telehealth.hhs.gov/providers/getting-started).  

5. Locum tenens and telehealth 

Many physicians are interested in working telehealth shifts as locums. 

CHG Healthcare staffs over 125 physician specialties in both hybrid and full telehealth environments in all 50 states and multiple international locations. CHG can stand up an entire staffing pool or supplement an existing physician group, and all providers are screened and credentialed to meet quality requirements.  

 

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References

1. Survey of Telehealth Use by Commercial Insurance Enrollees. AHIP, Dec. 1, 2022. https://www.ahip.org/resources/survey-of-telehealth-use-by-commercial-insurance-enrollees

Dive Brief:

• The Drug Enforcement Agency said last week it is “open to considering” a special registration that would allow physicians to prescribe some controlled substances through telemedicine without an in-person evaluation after receiving negative feedback earlier this year on proposed rules that would have restricted the practice.
• The proposals, announced in March, would limit telemedicine prescriptions for some controlled substances to a 30-day supply, after which a provider would have to evaluate a patient in person to continue the prescription. The agency said it received more than 38,000 public comments in response, with “a significant majority” expressing concern about the proposed rules. 
• The DEA will host listening sessions on Sept. 12 and 13 to discuss permitting telehealth prescribing without in-person evaluations.

Dive Insight: 

During the COVID-19 public health emergency, the DEA stopped enforcing the Ryan Haight Online Pharmacy Consumer Protection Act of 2008 — a law that requires providers to have previously conducted an in-person evaluation to virtually prescribe controlled substances — to avoid lapses in care.

The COVID flexibilities were set to expire at the end of the public health emergency, but the DEA temporarily extended them in May after receiving tens of thousands of public comments on its stricter proposed rules. 

“DEA is open to considering — for some controlled substances — implementation of a separate Special Registration for telemedicine prescribing for patients without requiring the patient to ever have had an in-person medical evaluation at all,” the agency wrote in a meeting notice. 

Telehealth prescribing could be a boon in combating the opioid epidemic, which worsened at the height of COVID. The availability of opioid use disorder-related telehealth services and medications has been linked with a lower likelihood of drug overdose deaths among Medicare beneficiaries. 

Prescriptions for other medications like stimulants, usually for treating ADHD, increased between 2016 and 2021, according to data from the Centers for Disease Control and Prevention. While easier access to stimulants may be beneficial for some patients, the agency flagged concerns about adverse effects like misuse, overdose or interactions with other medications.

Organizations like the American Telemedicine Association and the American Hospital Association have argued in-person requirements limit access to care, particularly for substance use disorders.

Dive Brief:

• Telehealth groups are cheering after a bipartisan group of 60 senators reintroduced the CONNECT for Health Act last week, which would make pandemic-era virtual care flexibilities permanent if passed.
• It’s the second time the bill has been reintroduced in Congress as proponents of virtual care look to solidify COVID-19 gains in telehealth accessibility and use before temporary flexibilities run out at the end of 2024.
• Companion legislation has also been introduced in the House.

Dive Insight:

Permanently expanding telemedicine access has broad bipartisan support in Congress. A number of bills have been introduced to codify more telehealth protections after COVID-19, including CONNECT, which is considered the most comprehensive virtual care legislation by advocacy groups.

Since CONNECT was first introduced in 2016, a number of the bill’s original provisions have been enacted into law or adopted as policy by the CMS, including in the early days of the COVID-19 pandemic as Washington threw open the doors to broader telehealth use. Then a 2022 spending package extended a number of the changes through Dec. 31, 2024, giving regulators and Congress more time to analyze telehealth efficacy in Medicare and make any desired COVID-era changes permanent.

The updated CONNECT act would permanently remove geographic restrictions on telehealth services, expand originating sites to include the home and permanently allow health centers and rural health clinics to provide telehealth. It would also remove the six-month in-person visit requirement for telemental healthcare and permanently allow telehealth restrictions to be waived during public health emergencies.

CONNECT is endorsed by more than 150 industry organizations, according to the office of Sen. Brian Schatz, D-Hawaii, who led reintroduction of the bill.

Telehealth groups including Telehealth Access for America, the American Telemedicine Association and the College of Healthcare Information Management Executives came out with statements applauding legislators for the bill’s reintroduction.

“Telehealth is an issue that has consistently attracted bipartisan, bicameral support and we are very encouraged at the incredibly strong Congressional show of support, to this day,” said Kyle Zebley, ATA’s head of public policy.

Proponents argue that enshrining heightened access to telehealth will preserve continuity of care while removing obstacles many patients face in accessing services, including the cost and distance of travel.

Studies suggest that older adults and people from underserved communities benefited the most from expanded telehealth access during the pandemic, and that telehealth doesn’t contribute to duplicative care, as some feared, but instead acts as a substitute. However, overall research on that is mixed, as some studies have found telehealth increases overall utilization.

Dive Brief:

• Teladoc Health is expanding its partnership with Microsoft, announcing plans to add artificial intelligence tools for clinical documentation to its telehealth platform for hospitals and health systems.
• The companies will work to integrate Microsoft Azure’s OpenAI Service and Cognitive Services and Microsoft-owned Nuance’s Dragon Ambient eXperience into its Solo platform, allowing physicians to automatically transcribe clinical notes during virtual patient exams.
• Teladoc’s medical group also plans to use DAX Express, a version of the medical scribe that uses the large language model GPT-4 and doesn’t require human authentication, the New York-based telehealth vendor said. Financial terms of the deal were not disclosed.

Dive Insight: 

Teladoc first partnered with Microsoft two years ago to integrate its telehealth platform for health systems with the chat and video call service Teams. The combination was meant to ease administration burden and access to telehealth tools for clinicians, the companies said.

Teladoc and Microsoft argue their latest integration will achieve similar goals, by cutting back on documentation time and allowing providers to focus more on patient care. 

Providers spend hours each day in electronic health records. Studies suggest that documentation burden could contribute to burnout. 

“Administrative burden and staff shortages are major reasons why clinicians are leaving the profession,” Vidya Raman-Tangella, Teladoc’s chief medical officer, said in a statement. “We are focused on using AI to reassert and build the doctor-patient relationship at a time when technology frequently does the opposite.”

Teladoc and Microsoft are currently piloting the DAX and Solo integration, according to a spokesperson. Ultimately, any Solo hospital client using Teams and an Epic electronic health record will be able to use the tool, as long as they purchase a DAX license.

For Teladoc’s medical group users, the telehealth company and Nuance are working to train its AI models for use on virtual urgent care visits before expanding it to Teladoc’s other services, like primary and mental healthcare, the spokesperson said. 

Generative AI, which creates new content like text or images, is an increasingly hot topic in the healthcare industry. Documentation is one potential use case for the technology, along with creating discharge summaries or pulling together benefits information.

But there are also concerns about accuracy, bias and accountability when using these tools. Some experts have argued the industry should slow their adoption and take time to develop guidelines for the technology. 

Nuance, which was acquired by Microsoft last year, has been expanding in the space, integrating OpenAI’s large language model GPT-4 into DAX Express in the spring. The medical scribe can also be used with EHRs made by Epic, the largest records vendor in the U.S. hospital space.

Microsoft expanded its own partnership with Epic in April to integrate its Azure OpenAI Service with the EHR software, including adding tools to automatically draft message responses to patients. 

Dive Brief:

• Telehealth patients across most medical specialties are less likely to attend follow-up appointments 90 days after a visit compared to in-person appointments, according to new research from Epic.
• The analysis of follow-up visits comes after a December report from Epic found most telehealth patients did not require a follow-up appointment in the three months after an initial visit. Mental health, physical medicine, and rehabilitation and pain medicine had the highest in-person follow-up rates compared to telehealth visits, according to the latest research.
• The new telehealth study comes as federal lawmakers debate whether to make pandemic-era virtual care flexibilities permanent before they expire in 2024. 

Dive Insight:

For the analysis, Epic surveyed 40.7 million specialty and 32 million primary care encounters between January 2022 and March this year. Although utilization soared during the pandemic, researchers in the study noted that telemedicine use was infrequent for most specialties, with only mental health and sleep medicine conducting at least 20% of their visits using telehealth.

In-person and virtual follow-up rates for primary care were within two percentage points of each other, according to the study, with family medicine having nearly equivalent follow-up rates. Mental health patients were 30.8% more likely to schedule a follow-up appointment after an in-person appointment, rather than a telehealth visit.

The findings show that telemedicine plays an important role in care delivery without requiring additional encounters from patients, researchers noted.

Federal legislators are currently deciding the future of telehealth for Americans. Last month, a bipartisan group of senators reintroduced the CONNECT act for a second time. The act would make pandemic-era telehealth flexibilities permanent, including those that remove the six-month in-person visit requirements for telemental healthcare and expand originating sites of care to include the home.

Previously, Epic researchers argued that payers should extend coverage to telehealth visits following the COVID-19 pandemic, noting in their December report that telehealth visits served as an alternative, rather than a duplicative, medical encounter.

Although some studies have shown that telehealth services can expand healthcare access to underserved communities, recent research from the KFF found that insurers paid roughly the same for telehealth and in-person visits during the COVID-19 pandemic. The findings pushed back on research arguing that telehealth saves the healthcare system money, KFF said. 

Dive Brief:

• The group that advises Congress on Medicare policy released a new report Thursday with recommendations on telehealth, overpayments to Medicare Advantage plans and site-neutral payments across some outpatient care settings.
• The Medicare Payment Advisory Commission, or MedPAC, included telehealth in the report to satisfy a mandate from Congress after virtual care surged during the COVID-19 pandemic. Telehealth coverage under Medicare was limited before the public health emergency, and it was expanded to preserve access to care.
• The report found fee-for-service Medicare spending for telehealth care was $4.8 billion in 2020 and $4.1 billion in 2021, more than 30 times greater than 2019. Early findings show more telehealth use was associated with little change in quality, slightly improved access to care for some beneficiaries and slightly increased costs to Medicare.

Dive Insight: 

MedPAC noted it’s difficult to assess telehealth’s impact because available claims data is from 2021, and policymakers should continue to monitor to see how such care affects access, quality and costs in the long-term.

Though telehealth use has generally declined from its pandemic highs, virtual care still remains elevated. Quality is one major concern for the industry, especially for audio-only telehealth, as some people lack high-speed internet that makes video more accessible.

Though the CMS paid the same rate for telehealth services as in-person care during the public health emergency, MedPAC recommended switching back to the lower facility rate “as soon as practicable after the PHE.”

The commission also examined favorable selection of beneficiaries in Medicare Advantage, where private insurers receive set payments to manage Medicare plans. According to research released earlier this week from the USC Schaeffer Center for Health Policy & Economics, overpayments to Medicare Advantage plans could reach more than $75 billion this year as beneficiaries who leave traditional Medicare for MA have lower expenditures than those who stay.

MedPAC estimated MA beneficiaries’ spending in 2019 was about 11% lower than traditional enrollees’ spending with the same health risk scores. 

“These findings raise major concerns about the appropriateness of continuing to base MA benchmarks exclusively on Medicare FFS spending data. Those concerns are heightened as more beneficiaries enroll in MA and the share of Medicare beneficiaries enrolled in FFS declines,” the commission wrote. “If the number of FFS beneficiaries in a county becomes too small, Medicare’s estimates of FFS spending for the county could become unstable, as small changes in enrollment or health service delivery can cause large shifts in average spending.”

MedPAC also recommended setting similar payment rates for some services across outpatient settings, like hospital outpatient departments, ambulatory surgical centers and freestanding physician offices.

Lawmakers have recently shown support for site-neutral payments, though hospitals generally oppose them. The American Hospital Association said MedPAC’s recommendation “would redistribute $7.5 billion in Medicare spending for certain services performed in outpatient departments and ambulatory surgical centers,” particularly harming rural hospitals.

In the report, MedPAC argued more closely aligning payments for outpatient services would impact hospitals differently and concerns about specific groups should be dealt with through targeted assistance, rather than keeping higher rates.

Dive Brief:

• The Federal Trade Commission and the HHS’ Office for Civil Rights are warning hospitals and telehealth companies about embedding online tracking technologies on their websites or apps, saying the trackers risk exposing consumers’ personal health data to third parties. 
• The trackers, like the Meta Pixel or Google Analytics, collect identifiable information about users and could reveal information about health conditions, diagnoses, treatments, frequency of visits and more, the agencies wrote in a letter to about 130 health systems and telehealth providers.
• The warning marks the latest move from regulators regarding the healthcare industry’s use of tracking technologies, which monitor user behavior on websites. Sharing consumers’ health data with third parties, like advertisers, has been a recent target of FTC oversight. 

Dive Insight: 

The use of tracking software among healthcare companies is common, according to research and media reports. The technology is used on almost 99% of hospital websites, one study found.

A recent investigation by STAT and the Markup found a significant number of direct-to-consumer telehealth websites were sharing users’ sensitive information with tech companies using these tracking tools. For example, 49 out of 50 of the websites shared which URLs consumers visited, while 35 sent personal information like name and email address and 13 collected data on consumers’ answers to questionnaires. 

Regulators have been cracking down on telehealth and digital health companies sharing data with third parties, warning that entitles not covered under the HIPAA privacy law are still subject to other regulations, like the FTC Act and the Health Breach Notification Rule.

The FTC recently fined drug cost tool GoodRx, Teladoc-owned mental health company BetterHelp and fertility app Premom for sharing health data with advertisers. 

“The FTC is again serving notice that companies need to exercise extreme caution when using online tracking technologies and that we will continue doing everything in our powers to protect consumers’ health information from potential misuse and exploitation,” Samuel Levine, Director of the FTC’s Bureau of Consumer Protection, said in a statement. 

Dive Brief:

• London-based digital health startup Babylon will go private as part of a deal with investment manager AlbaCore Capital Group and its affiliates, the company announced Wednesday. Babylon will receive $34.5 million in interim funding in addition to an amendment of its $300 million loan agreement from AlbaCore.
• Babylon posted a $63 million loss for the first quarter of 2023, compared with a loss of $29.1 million in the first quarter of 2022. The company’s NYSE stock price was cut in half Thursday, dropping from $2.05 to around $1.28 a share.
• AlbaCore plans to help the company with its long-term restructuring process, including developing a long-term employee incentive plan for Babylon.

Dive Insight:

The news is a reversal of course for Babylon. The company went public in October 2021 in a merger with special purpose acquisition company Alkuri Global Acquisition Corp. SPAC deals accelerated during the pandemic to help digital health companies raise money and coincided with an increase in telehealth use during that time.

Founded in 2013, Babylon offers integrated primary care along with remote consultations with doctors on the web or via a mobile app. It uses artificial intelligence to power virtual diagnoses and medical appointments. 

Babylon will receive the interim funding in May or early June if it meets certain conditions, according to the company.

The virtual care company is also exploring a sale of the Meritage Medical Network/Independent Physician Association business. Meritage offers in-person care for close to 90,000 members and more than 12 insurers in Northern and Central California. The sale allows Babylon to focus on its core mission of virtual care.

“The sale of our IPA business and streamlining of our reporting and governance processes will result in a more focused business, simpler structure and stronger balance sheet,” Ali Parsa, Babylon’s founder and CEO, said in an October 2022 statement.

Dive Brief:

• Telehealth giant Teladoc Health is expanding its physician-based care product for employers to weight management and prediabetes, as interest explodes in drugs meant for diabetes control that are being more frequently prescribed for weight loss, resulting in nationwide shortages.
• The medications, called GLP-1 drugs, include Novo Nordisk’s Ozempic, which has been at the center of a national conversation about health, weight loss and medication access as more people, especially celebrities, use the drug to lose weight.
• The provider-based program, which includes access to a Teladoc-employed doctor for a personalized care plan, along with daily coaching with digital tools, will become available for diabetes prevention and weight management in the third quarter, the company told Healthcare Dive.

Dive Insight:

Teladoc’s provider-based care program is designed to help members lose weight and avoid developing diabetes by using medications, including GLP-1 agonists, along with other Teladoc tools to address the full range of cardiometabolic health risk factors, the company said. Other tools include nutrition logging and coaching, activity tracking and sleep management.

Depending on a patient’s needs, members can receive a combination of care including a continuous glucose monitor, lab work and a drug prescription through a series of visits with a Teladoc physician, according to the company.

The care program is already available for diabetes and hypertension. Teladoc cited the growing prevalence of obesity in the U.S. as its motivation to expand the program to weight management and prediabetes, along with the rising popularity of GLP-1 therapies.

GLP-1 drugs have been available to treat diabetes for years, but have made headlines recently for purported weight loss benefits. As more people have rushed to procure the drugs to shed pounds, many patients with diabetes have struggled to access the medication, especially as prescriptions became more widely available online.

A handful of digital health companies, including Ro and Sequence — a telehealth platform recently acquired by WeightWatchers — advertise quick and easy access to the drugs. Experts say online prescribing, where telehealth companies might not have access to a patient’s full history or rigorous intake requirements, could result in fragmented care or misuse.

Teladoc said it applies evidence-based guidelines to prescribe GLP-1s only when clinically appropriate.

“There is no doubt that GLP-1s can be a critical tool in the management of cardiometabolic disease, particularly weight management, but they work best as an addition to altering long-term habits that address nutrition, activity, sleep and stress management,” a Teladoc spokesperson said.

Teladoc declined to shares sales numbers for the provider-based care program, but said early interest from employers was strong.