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Published in Health Care

Insurance reimbursements, new virtual-first coverage plans to help ensure telehealth’s growth

BY Sunday, January 03, 2021 05:10pm

As COVID-19 emerged last spring and closed physician offices for non-essential care — forcing connections with patients via telehealth platforms — health insurers began to pay doctors the same for virtual visits as they do for in-person care.

That reimbursement level continued into 2021 for many health insurers.

How insurers set future reimbursement levels will make a difference in how telehealth grows and evolves, said Dr. Khan Nedd, CEO of Grand Rapids-based Answer Health LLC, an umbrella organization for 200 physician practices in the western Lower Peninsula with more than 1,000 care providers.

If health insurers after the pandemic no longer pay physicians the same for virtual care as office visits, “then essentially what you’re doing is really getting people to go back to what they were doing,” negating the progress of telehealth, Nedd said.

That potential requires physician practices to examine where telehealth fits into the business in the future and how they can meet higher patient demands for virtual care, even if the reimbursement rate changes.

“A lot of what happens in health care is aligned to who is paying and what’s being paid,” Nedd said. “We have to get payers to really understand why this is going to become a tool and how payers can work together with physicians to accomplish the very end that we all are trying to get to.”

Virtual visits are giving doctors more time with patients, and “probably greater outcomes at less cost,” on top of providing greater efficiency and access to care for patients, Nedd said.

Like many organizations, Answer Health experienced rapid telehealth growth in 2020. Early in the pandemic in March, Answer Health brought aboard more than 50 practice sites in two weeks, according to Colby Crittenden, the firm’s manager of business development. 

Virtual-first coverage policies

As health systems and physician practices turned to telehealth and consumers embraced the platform, some insurers also introduced new policies that emphasize telehealth as the first option for primary care.

Priority Health in October launched MyPriority Telehealth PCP for coverage that started Jan. 1. Enrollees in MyPriority Telehealth PCP are assigned a primary care physician through the national telehealth platform Doctor on Demand and do all visits virtually. The policy provides full coverage for preventative care.

“Telehealth is certainly here to stay,” said Curtis Gritters, Priority Health’s director of contracting. “Consumers, providers and insurers are all working together to learn how to deliver care and receive care in safe and comfortable ways during the pandemic, and our telehealth plans were a way that Priority Health responded.”

Early data during the recent open enrollment period showed the “market responded well” to the plan’s introduction, he said. More than 5,000 people enrolled in MyPriority Telehealth PCP, with some switching from other individual health plans Priority Health offers.

Priority Health brought the individual virtual-first plan to market after spikes in telehealth claims. In April 2020, one in every five member visits to a doctor was done virtually. That compares to one in 1,000 in April 2019, according to Gritters.

Telehealth claims flattened during the summer and fall, yet remained far above pre-pandemic levels at one in every 20 doctor visits by a Priority Health enrollee, Gritters said.

Detroit-based Health Alliance Plan also introduced two virtual-first policies in the fall for 2021 coverage. HAP’s Virtual Care Plan for individuals and families now has 1,000 enrollees. A narrow network product called Pivotal for large employers in Southeast Michigan works with telehealth care providers at parent corporation Henry Ford Health System. Both have zero member cost sharing for virtual visits.

HAP includes telehealth coverage across all of its policies and introduced the virtual-first policies to “remove some barriers to people getting access to care,” said Margaret Anderson, HAP’s senior vice president and chief sales and marketing officer.

The telehealth plan for small businesses had a high level of quote activity during the recent open enrollment period, indicating that employers at least want to consider virtual-first policies as an option for employees to consider.

“There is a bit of a learning curve and maybe a slower adoption rate when you think of employer groups,” Anderson said. “We need to get better at explaining the value proposition and how it’s a lot better if you have an employee take 15 minutes to do an e-visit than it is for them to take a half day off” to see a doctor.

Most employers already include telehealth coverage in their employee health benefits, according to Melissa Sluss, director of employee benefits at Lighthouse Group insurance agency in Grand Rapids.

The ability to reduce absenteeism is one way that Lighthouse Group promotes telehealth to employers, Sluss said. Employees who need to see a doctor during the day can do a virtual visit from work, she said.

“That’s how we’ve historically been able to get traction with it with our clients: Helping them understand it’s a benefit for their employees and it’s a benefit for the company, too,” Sluss said.

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