Patient Care Access News

Patients Unclear About Access to Telehealth Under their Health Plans

Forty-six percent of Medicare Advantage patients were unsure of their health plans' access to telehealth policies.

access to telehealth

Source: Thinkstock

By Sara Heath

- Nearly half of Medicare Advantage patients are unsure of whether their health plans cover access to telehealth or virtual care services, according to recent HealthMine data.

The survey of just under 800 Medicare Advantage beneficiaries showed that 46 percent of patients are unaware of the telehealth and virtual care services covered by their current health payers. Thirty-seven percent of patients said their payers do not cover virtual care, while 17 percent said their payers do cover access to telehealth.

This is not for lack of patient interest in telehealth. The HealthMine survey showed that Medicare Advantage patients are well-equipped to use telehealth and other virtual care tools. Seventy-seven percent of patients currently use a digital health device. And by virtue of the survey being conducted online, the survey administrators were able to conclude that all respondents had proficient digital health literacy.

Additionally, a separate 2017 survey from the Advisory Board showed that nearly three-quarters of patients want access to telehealth or digital health. Nineteen percent of patients have already utilized these tools, the Advisory Board reported.

Limited patient knowledge about telehealth coverage is also not for lack of coverage, HealthMine noted. CMS and other federal agencies have made recent payment rule changes that would reimburse providers for telehealth use.

Specifically, July 2018 proposed changes noted that telehealth is a key avenue toward better patient care access, which is one of the agency’s top priorities, according to CMS Administrator Seema Verma. Additionally, telehealth represents a low-cost option for patients accessing care, a key initiative in an industry with growing consumer costs.

“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,” Verma said.

Specifically, the CMS announced changes to the 2019 Physician Fee Schedule that would pay clinicians for virtual check-ins, evaluation of patient-submitted photos, and expand Medicare’s telehealth payments to include prolonged, preventive services.

These proposals from CMS are another step toward better patient access to telehealth, which HealthMine president and CEO Bryce Williams says will help patients access more affordable healthcare.

On the whole, the time is ripe for more health plans to make telehealth options available to patients and to educate patients on their plans’ coverage, Williams explained.

“For Medicare Advantage plans, telehealth seems to be a perfect storm to lower cost,” Williams said in a statement. “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.”

“Finally, CMS is taking steps to expand Medicare-covered telehealth services to include prolonged preventive services,” Williams added. “The smart Medicare Advantage plans are already educating members how, when and where to use telehealth. A $40-$50 telehealth visit, versus an in-person visit for a routine procedure, could mean millions in savings for a plan. And, it will add up to billions in savings for overall Medicare.”

Despite room for improvement, these are better results than HealthMine saw in 2017. A similar survey conducted last year found that more than half (57 percent) of Medicare Advantage beneficiaries did not know whether their plan covered telehealth and virtual care services.

Thirty-one percent of 2017 respondents said their plan did not cover telehealth visits, while 14 percent said their health plan did cover virtual care.

Going forward, more health plans will need to weigh the costs and benefits to covering patient telehealth visits. Plans that do extend these services to patients must ensure patients are aware of this covered benefit, as well as how and when to access telehealth.


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