Exciting advances notwithstanding, the burden of proof remains on telemedicine and telehealth tools to prove their value in delivering higher quality care while simultaneously reducing costs, a panel of experts at the Telemed Leadership Forum 2018 told attendees March 27 in Washington, D.C.
“The employer market is a huge opportunity for telemedicine,” Adam Solander, health industry attorney with Epstein Becker and Green, told attendees. “It’s fluid right now and will probably continue for the next decade.”
The prospect of cost savings via telehealth and telemedicine is more and more tantalizing for employers bracing for steep rises in health plan costs, he said. They are looking for both short- and long-term solutions, and telemedicine can be a big part of that. “That’s where I see it come in,” Solander said.
Employers are also looking for ways to use telemedicine and telehealth to target specific disease areas and cost drivers, including diabetes and hypertension, he added.
However, it’s up to telemedicine advocates to make the right strategic moves to take advantage of the opportunities presenting themselves, Solander cautioned. Broadly speaking, it’s not being done well today, and the result is “we’ve not seen the adoption [levels] we’d hoped.” He offered several suggestions:
- Know what you are. Understand what benefit you are offering. Are you offering a medical benefit that can only be offered to plan participants, or are you offering a disease management program open to others? “That makes a huge difference,” he said. If you offer services outside employee benefit members, it gives you more flexibility in the market.
- Know the plan design you are fitting into. “I can’t tell you how many programs that I have negotiated with large employer clients, and the telemedicine company comes to us with a service we can’t really place” into its offerings without disrupting or invalidating existing benefits, such as HSAs.
- Develop a payment model that makes sense. “Employers are looking at these plans as a way to reduce costs,” he said. It’s less about utilization levels. Some clients have seen utilization as low as 3%, others as high as 20%. It all depends on their populations.
While he’s bullish on many aspects of telehealth and telemedicine, Rene Quashie, healthcare and telemedicine attorney with Cozen O’Connor, cautioned there’s something of a mixed message coming from the federal government when it comes to telehealth and telemedicine. He provided analysis of a major new report from The Medicare Payment Advisory Commission (MedPAC), “Report to the Congress: Medicare Payment Policy.”
It’s important to look at the issues raised in the report, he says. “I think it gives a window into what the federal government view of telehealth is.” It looks at how Medicare and commercial insurers cover telehealth, and whether Medicare can take ideas from the commercial side to inform its coverage.
Among the reports most important findings: Plans have now found strong evidence that telehealth reduces cost [but] cite competitive pressure rather than cost reduction as a motivation for covering telehealth. “In other words, there’s not full buy-in yet,” says Quashie.
“I don’t think MedPAC is saying telemedicine doesn’t save money, [instead] they’re saying there is no clear evidence. We don’t have the studies.”
Even when assessing mental health services, a relative strong point in telehealth and telemedicine delivery history, Quashie interprets the report’s findings to say, “they’re not sold on telemental health services actually providing the same level quality and outcomes while at the same time increasing the costs,” he says. “That is a huge problem” facing increased adoption of telemental health coverage, he adds.
He found some silver linings in the cloudy weather report from MedPAC. Broadly speaking, the report appeared to look favorably upon telehealth in the arenas of stroke, kidney disease, and Parkinson’s. “Everything else is up in the air.”