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CMS Proposal Expands Telehealth Coverage: What Payers Should Do Now


A HealthMine survey has interesting results about Medicare Advantage members’ knowledge about virtual care. Here’s six ways to reach them.



As CMS seeks to expand Medicare-covered telehealth services to include prolonged preventive service-which will create more opportunities for Medicare patients to access personalized care management and connect with physicians quickly-few Medicare Advantage plan members know if their plan offers telemedicine, according to a new survey.

The survey from HealthMine of 781 Medicare Advantage members shows that 46% were unsure if their plan offers telehealth, 37% said it is not offered, and 17% noted it is offered. 

“The study was conducted to better understand Medicare Advantage members’ perceptions of their relationship and effective use of their health plan,” says Bryce Williams, president and CEO of HealthMine. 

In a July statement from CMS announcing the proposed program, Administrator Seema Verma said, “CMS is committed to modernizing the Medicare program by leveraging technologies, such as audio/video applications or patient-facing health portals, that will help beneficiaries access high-quality services in a convenient manner.”

For Medicare Advantage plans, telehealth seems to be a perfect storm to lower costs, Williams says. “First, awareness of telehealth will only grow with better diagnostics; second, there are 10,000 baby boomers per day becoming Medicare eligible, which means that we will have more beneficiaries who are technologically proficient.”

Savvy Medicare Advantage plans are already educating members how, when, and where to use telehealth, according to Williams. “A $40 to $50 telehealth visit, versus an in-person visit for a routine procedure, could mean millions in savings for a plan,” he says. “And, it can add up to billions in savings for overall Medicare.”

Because telemedicine is less expensive compared to an office visit, urgent care visit, or emergency room visits, plans should run programs to get members to try telemedicine, according to Williams.

“Initially, many members may be afraid of new service like telemedicine-but most members probably remember when they could just call the family doctor,” Williams says. “This is going back to that convenience for many ailments like a cold, or common aches and pains. Telemedicine can range from a phone consultation to a video consultation via smart device or computer.” 

The starting point is to use existing communication with members to inform them about telemedicine, Williams says.

Here are examples of ways to communicate with members about telemedicine:

  • Add a large font advertisement to any existing printed materials being sent to members.
  • Add telemedicine information to the “on hold” phone queue: “Hey, did you know you can meet with a doctor without having to leave home?”
  • Offer telemedicine in call center interactions with the member. Run a campaign for operators to share with any inbound callers and/or create a computer dialed and delivered voicemail with a 15-second message telling the member about telemedicine availability and how to use it.
  • Add telemedicine as a way to receive care on the front page of your website.
  • Send secure text with link to telemedicine services.
  • Consider offering a member’s first telemedicine consultation for free. “When a plan considers that savings of a single telemedicine versus an in-person visit can be hundreds of dollars-getting members to try telemedicine can overcome fears and give a real comfort level in using the service moving forward as appropriate,” Williams says. “The increased use of telemedicine could save plans thousands, if not millions of dollars.”
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