Telehealth reimbursement under the microscope
In this commentary, attorney Nathaniel Lacktman shares why, in the era of payment reform, it is critical for health plans to provide telemedicine reimbursement.
LacktmanHealth plans must embrace telehealth services. This is true whether you run a Medicare Advantage plan, a Medicaid managed care organization, a commercial health plan, or an employer-sponsored plan.
Not only is telehealth currently the best vehicle to promote care management by increasing patient "touches" and enhancing the doctor-patient relationship, it is a paved pathway for providers and payers to develop viable risk-sharing payment models, whether through value-based purchasing, shared savings, full subcapitation or otherwise.
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Yet, commercial health plans have historically not covered telehealth-based services as a member benefit. As a result, many of the early telehealth programs were built around cost-savings models, patient self-pay, or employer-sponsored payments. The current telehealth technical infrastructure and professional expertise makes these providers perfectly-suited partners for health plans seeking a turnkey solution to improving access and quality in the plan’s member population. Put another way, there are hospitals and providers out there with “telehealth Ferraris” just waiting for a health plan to bring the gasoline.
Due to this historical unwillingness to cover telehealth, states have enacted laws requiring commercial health plans to cover services provided via telehealth to the same extent the plan covers services provided in-person. These laws are designed to promote private sector innovation by catalyzing providers and plans to use the powerful telehealth technologies available in the marketplace.
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