Insurance payers that consider adding telehealth services and technology can expect a better health management outcomes for their members and better opportunities for care coordination. 

May 16, 2018 by Thomas Beaton

Payers that include telehealth and remote care benefits in their health plan options could position themselves as leaders in health plan value, convenience, and innovation.

Health plans are challenged to improve customer service and member satisfaction in an industry that has not produced ideal member experiences.

Commercial health plans are falling behind other industries in key consumer satisfaction metrics, including convenience, helpfulness, and user-friendliness. Providing telehealth options could provide an opportunity for payers to address some of these concerns.

Telehealth is a serviceable healthcare delivery tool since many state governments have lowered legal barriers to telehealth adoption.

Last year, 64 bills were approved by 34 state legislatures that expanded telehealth reimbursement, removed reimbursement barriers, and increased participation in interstate licensure agreements.

These bills created new policies such as expanding opportunities for behavioral healthcare, adding telehealth services into schools, and providing broadband internet expansion for rural areas to support telehealth delivery.

Within a telehealth-ready consumer base, what the opportunities for payers that provide telehealth and remote care benefits?

Opportunities for using telehealth and mHealth

Telehealth is a promising opportunity to increase member engagement because a greater number of individuals are open to the use of telehealth services.

Telehealth and remote care provide an exceptional customer experience opportunity for payers. Consumers want telehealth as a convenient way to receive checkups, preventive care, and non-critical services without the need for travel and wait times.

Recent consumer surveys on telehealth use found that 77 percent of consumers said they would be more likely to choose a telehealth visit over an in-office visit for routine or non-emergency matters. However, many consumers still would prefer the option to see their providers in person for pressing healthcare concerns.

Telehealth visits also have the potential to add highly-convenient healthcare options for consumers, according to the survey findings.

Twenty-six percent like the option of skipping trips to and from the doctor’s office, 25 percent want to access healthcare in the comfort of their home, 20 percent want quick care access, and 16 percent like shorter wait times.

Insights from a Change Healthcare survey of commercial payers view telehealth and digital engagement tools as growing opportunities to increase member satisfaction. Thirty-six percent of payers used telehealth to improve member engagement while 11.9 percent used instant messaging services to address customer service issues.

Telehealth and mHealth reimbursement challenges

Telehealth reimbursement has payment parity limitations, meaning that telehealth services are not reimbursed at the same level as in-person visits.

Thirty-three states have telehealth parity laws, and stakeholders have argued that parity is needed to make it financial viable for providers to offer telehealth services.

However, payer organizations including BlueCross BlueShield of Kansas City have argued that telehealth parity laws restrict a payer’s ability to negotiate prices for visits based on the true value delivered. Telehealth visits often have different purposes than traditional face-to-face visits, and may not be a part of a long-term relationship between a patient and a provider, said Coni Fries, Vice President of BCBS of Kansas.

“Telemedicine services are not equivalent to in-person services and, therefore, should not receive parity to in-person services in reimbursements,” Fries said. “Primary care physicians are paid at a higher rate because we expect them to manage our members’ care throughout the year. On the contrary, telemedicine appointments might be one-time engagements.”

Providing telehealth and remote care to rural beneficiary populations may also prove challenging to payers. Payers with a larger rural beneficiary population may not be able to provide members with telehealth services unless broadband issues are addressed.

Rural areas with poor broadband connectivity sometimes don’t have the capability to connect to telehealth services. Poor broadband connectivity can disincentivize state governments from expanding telehealth.

Broadband issues caused Montana, one of the country’s most rural states, to close the door on legislation that would have set telemedicine practice standards. Federal agencies such as the FCC are attempting to remedy rural telehealth issues by increasing broadband investments.

Telehealth and remote care applications for member benefits

Commercial payers have experimented with telehealth and remote care benefits to successfully improve care coordination, beneficiary satisfaction, and healthy behaviors.

Telehealth benefits and services can provide additional support for payer wellness programs that keep beneficiaries healthy and out of the hospital.

For example, BlueCross BlueShield of Nebraska piloted and then expanded an mHealth platform that helps beneficiaries reach providers through multiple communication channels for members involved in chronic disease and wellness coaching programs.

Payers can address challenges related to medication non-adherence by offering benefits that use telehealth, text messaging, and digital engagement to ensure beneficiaries maintain their prescription treatments.

Last year, Humana launched an mHealth app that uses digital engagement to get members to maintain prescription treatments and plans to integrate with other member interfaces.

Telehealth and digital health solutions also allow payers to better serve their employer customers and enhance employer-sponsored insurance products.

BCBS of Massachusetts recently expanded a digital health platform to promote diabetes management, parenthood guidance, and other self-care within employer-sponsored groups.

Healthcare payers should consider the immense opportunities that telehealth and similar remote care benefits can provide to health plan value, but also need to understand that considerable investments are required to provide telehealth services.

Payers that have younger, digitally savvy beneficiaries in areas with high broadband connectivity could provide members with connected healthcare experiences and on-demand healthcare purchasing. Conversely, payers that have large groups of rural beneficiaries may need to invest in additional broadband or technology expansions to provide telehealth services to areas with lower internet connectivity.

In addition, a key to successfully providing telehealth is working with providers to fairly negotiate reimbursement under payment parity laws. Payers that collaborate alongside providers can help determine fair and reasonable rates based on patient outcomes and cost-effectiveness of healthcare.

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