Insurers to CBO: Consider Private Insurers’ Data in Evaluations of Telemedicine | Healthcare Informatics Magazine | Health IT | Information Technology Skip to content Skip to navigation

Insurers to CBO: Consider Private Insurers’ Data in Evaluations of Telemedicine

October 26, 2016
by Heather Landi
| Reprints

Eleven private insurers, including Aetna, Humana and Anthem, are urging the Congressional Budget Office (CBO), in a public letter to CBO director Keith Hall, to consider the experience of commercial insurers when evaluating the impact of telemedicine coverage in Medicare.

In the letter sent last week, the representatives of Aetna, Anthem, Blue Cross Blue Shield of Tennessee, Cambia Health Solutions, CareSource, EmblemHealth, HMSA-Blue Cross Blue Shield of Hawaii, Horizon Blue Cross Blue Shield of New Jersey, Humana, Molina Healthcare and MVP Health Care, noted that there is significant congressional interest in breaking down barriers to telemedicine access in Medicare. “We believe our experience in the commercial market can inform estimates of the impact of policy changes in Medicare,” the insurers wrote.

“We view telemedicine as an important tool in increasing consumer access to high quality, affordable healthcare, improving patient satisfaction and reducing cost. Given recent advances in technology, telemedicine gives customers a new way to be more engaged in their care, and save time and money. Additionally, telemedicine contributes to the value-based care goals of patient engagement, expanded hours for primary care, population health management and care coordination,” the insurance companies stated in the letter.

In a press release about the letter, representatives of Cambia Health Solutions further wrote, “Telemedicine is only permitted in Medicare under a very narrow set of circumstances, but there is a major bi-partisan effort to change the law and expand access. Legislation in Congress must be evaluated by the CBO, but because of the restrictions on telemedicine usage in Medicare, there is limited Medicare data. In light of this lack of data, the CBO should consider the effects that telemedicine’s expansion in the commercial market has had on access, health outcomes, and costs when estimating the budgetary effects of making telemedicine benefits in Medicare commensurate with the rest of the American healthcare system.”

The commercial insurers point out in the letter that CMS has allowed or included coverage of telemedicine in their new payment models, and Congress included telemedicine in clinical improvement activities as part of the Medicare Access and CHIP Reauthorization Act. Additionally, other public payers such as state Medicaid agencies, the Department of Defense and the Veterans Administration are adopting telemedicine services.

“As you know, actuaries in the insurance industry conduct careful analysis before coverage decisions are made. Available data supports the value proposition of telehealth and shows that there are significant savings to be gained even as it increases access to care,” the commercial insurers stated in the letter.

The company leaders also stated that one public actuarial study that examined data from five leading telemedicine platforms found that telehealth services results in savings.

“Data from that study suggested that, on average, 83 percent of telehealth visits resolved the clinical issue for which care was being sought via telehealth, requiring no additional follow-up care. Patients therefore have no need to go to urgent care, the ER or the doctor’s office. We would be happy to facilitate a meeting between the appropriate CBO staff and representatives from our organizations to discuss our experiences with telehealth and share outcomes data we have seen to date in our commercial insurance programs,” the letter stated.

The commercial insurers also state that the barriers in Medicare hamper the ability to offer telemedicine services to Medicare Advantage customers.

“We have worked closely with CMS to find ways to provide telemedicine through MA plans, but can only do so as a supplemental benefit. Our options are also limited without congressional action to reduce barriers in the Medicare fee-for-service benefit. Congressional action depends, in part, on a budget impact analysis from your office. We encourage the Congressional Budget Office to look to data available in our commercial programs and other public programs to assist in informing utilization and cost estimates when evaluating potential cost impacts of removing barriers to utilizing telemedicine in Medicare,” the insurers stated in the letter.

 

 

Get the latest information on Health IT and attend other valuable sessions at this two-day Summit providing healthcare leaders with educational content, insightful debate and dialogue on the future of healthcare and technology.

Learn More

Topics

News

Analysis: Healthcare Ransomware Attacks Decline in First Half of 2018

In the first half of 2018, ransomware events in major healthcare data breaches diminished substantially compared to the same time period last year, as cyber attackers move on to more profitable activities, such as cryptojacking, according to a new report form cybersecurity firm Cryptonite.

Dignity Health, UCSF Health Partner to Improve the Digital Patient Experience

Dignity Health and UCSF Health are collaborating to develop a digital engagement platform that officials believe will provide information and access to patients when and where they need it as they navigate primary and preventive care, as well as more acute or specialty care.

Report: Digital Health VC Funding Surges to Record $4.9 Billion in 2018

Global venture capital funding for digital health companies in the first half of 2018 was 22 percent higher year-over-year (YoY) with a record $4.9 billion raised in 383 deals compared to the $4 billion in 359 deals in the same time period last year, according to Mercom Capital Group’s latest report.

ONC Roundup: Senior Leadership Changes Spark Questions

The Office of the National Coordinator for Health IT (ONC) has continued to experience changes within its upper leadership, leading some folks to again ponder what the health IT agency’s role will be moving forward.

Media Report: Walmart Hires Former Humana Executive to Run Health Unit

Reigniting speculation that Walmart and insurer Humana are exploring ways to forge a closer partnership, Walmart Inc. has hired a Humana veteran to run its health care business, according to a report from Bloomberg.

Value-Based Care Shift Has Halted, Study Finds

A new study of 451 physicians and health plan executives suggests that progress toward value-based care has stalled. In fact, it may have even taken a step backward over the past year, the research revealed.