telehealth

While plenty of telehealth and online drug dispensing companies have rolled out direct-to-consumer (DTC) offerings, two pharma manufacturers have unveiled their own digital platforms this year in a bid to streamline and simplify consumers’ experience with the U.S. health care system. Other drugmakers are likely to launch similar offerings, say industry experts, as they offer benefits to various stakeholders. Still, certain challenges exist for those stakeholders, and manufacturers will need to ensure that they take certain steps — both pre- and post-launch — to set themselves up for success while remaining compliant with various regulations.

On Aug. 27, Pfizer Inc. launched PfizerForAll, a “user-friendly digital platform designed to make access to healthcare and managing health and wellness more seamless for people across the U.S.” It is aimed at Americans with migraine, COVID-19 or flu and offers adult vaccinations for conditions such as COVID-19, flu, respiratory syncytial virus (RSV) and pneumococcal pneumonia.

Between 2019 and 2021, the use of remote physiologic monitoring (RPM) via wearable devices and mobile applications soared by more than 1,300% among Medicaid enrollees, which was driven by a small number of providers, according to a recent Health Affairs study.

Based on Transformed Medicaid Statistical Information System Analytic Files data from Jan. 1, 2019, to Dec. 31, 2021, the study found that the number of RPM recipients per 100,000 Medicaid enrollees increased from 2.1 recipients in 2019 to 29.6 recipients in 2021 and started to accelerate with the March 2020 onset of the COVID-19 public health emergency. Among over 5,600 distinct providers who billed RPM claims for Medicaid enrollees in 2021, more than half of the claims were from 5% of providers.

Between 2019 and 2021, the use of remote physiologic monitoring (RPM) via wearable devices and mobile applications soared by more than 1,300% among Medicaid enrollees, which was driven by a small number of providers, according to a recent Health Affair study.

Based on Transformed Medicaid Statistical Information System Analytic Files data from Jan. 1, 2019, to Dec. 31, 2021, the study found that the number of RPM recipients per 100,000 Medicaid enrollees increased from 2.1 recipients in 2019 to 29.6 recipients in 2021 and started to accelerate with the March 2020 onset of the COVID-19 public health emergency. Among over 5,600 distinct providers who billed RPM claims for Medicaid enrollees in 2021, more than half of the claims were from 5% of providers.

Although telehealth policies that were put in place in March 2020 following the onset of the COVID-19 pandemic are set to expire at the end of the year, congressional leaders are taking steps to extend the policies for an additional two years. Even if the legislation passes, more research needs to be done to assess the benefits and downsides of treating people virtually from a payer, provider and patient perspective, according to speakers at a May 1 panel organized by the National Institute for Health Care Management (NIHCM) Foundation.

The House Ways and Means Committee on May 8 unanimously advanced legislation that would preserve Medicare beneficiaries’ access to telehealth through 2026. Reps. David Schweikert (R-Ariz.) and Mike Thompson (D-Calif.) are sponsors of bill H.R. 8261, which is known as the Preserving Telehealth, Hospital, and Ambulance Access Act.

The ERISA Industry Committee (ERIC), a benefits trade group for large employers, launched an ad campaign attacking the Biden administration’s mental health parity policies — a notable escalation in plan sponsors’ intensifying opposition to the administration’s approach to mental health care access, which could ultimately lead to litigation.

In a press release, ERIC said it hopes to influence upcoming mental health parity regulation, noting that “departments of President Biden’s administration, including the U.S. Departments of Health and Human Services (HHS), Labor (DOL) and the Treasury are finalizing proposed rule changes regarding mental health and substance use disorder parity.” The expected rule would be a finalized version of a regulation released in September 2023, which calls for much stricter network adequacy standards than were required in previous parity rulemaking.

The typical cost for a patient-provider email messaging claim was $39 in 2021, including both the portion paid by health plans and by patients. Although insurers covered the full cost for 82% of these claims, the patients who need to pay out of pocket typically spent $25 on a typical email message, according to Peterson-KFF Health System Tracker.

Use of electronic health communications has exploded since the COVID pandemic as more patients are seeking medical care remotely. CMS introduced several new billing codes in 2020 to help health care providers bill patients and insurers for a range of digital health services including electronic visits or asynchronous patient portal messages that require medical decision-making and at least five minutes of clinician time over a seven-day period.

As Medicare members become increasingly comfortable with using technology to manage their care at home, tech-enabled vendors continue to flood the Medicare Advantage space to offer solutions aimed at everything from fall prevention and functional mobility to specific conditions like Alzheimer’s and cardiovascular disease. Speaking at the 7th Annual Medicare Advantage Leadership Innovations forum, held Jan. 30 and 31 in Scottsdale, Arizona, vendors and MA plans shared the nuanced and personalized approaches they’ve taken to engage seniors with digital solutions.

“I think one of the challenges with [seniors and] technology is trying to really navigate tension between high tech and high touch. And I think that’s one of the things that you need to really figure out with your members early on: What are their preferences and needs? What resources do they have available?” said Joel Salinas, M.D., chief medical officer with Isaac Health, who spoke on a member engagement panel moderated by AIS Health, a division of MMIT.

Numerous companies have developed health and well-being apps and programs, making it difficult sometimes for companies to assess them and choose which ones to offer their employees. With this problem in mind, UnitedHealthcare recently rolled out UHC Hub, a platform that helps self-insured employers select and purchase health and well-being programs.

The vendors participating in the UHC Hub include Teladoc Health, a leading telehealth company; Noom, a subscription-based app for weight management and healthier living; and Cleo, a company that offers support for parents and caregiving.

Former President and current Republican presidential candidate Donald Trump posted on TruthSocial on Nov. 25 that he is “seriously looking at alternatives” to the Affordable Care Act. He added that the failure to overturn the ACA during his presidency “was a low point for the Republican Party, but we should never give up!” Following Trump’s comments, Citi analyst Jason Cassorla wrote in a note to clients that “we got the sense that the Trump headline didn’t have as much of a dampening impact in comparison to the headlines from back in 2017 when the repeal/replace rhetoric was in full swing and Republicans offered alternative such as block grants and other considerations.” Cassorla added that “as the 2024 election rhetoric heats up, we remain watchful of any momentum change on this front.”

CVS Health Corp.-owned Aetna has reversed course on a previously announced telehealth coverage change, Politico reported. The insurer had planned on ending virtual coverage for intensive outpatient and partial hospitalization program care on Dec. 1, but an Aetna spokesperson told Politico that Aetna would no longer go through with that decision. Groups such as the American Society of Addiction Medicine and the Consortium Representing Eating Disorders Care raised concerns about the proposed change.

Fewer people with employment-based health plans visited primary care practices, while more have turned to telemedicine and urgent care clinics since the COVID-19 pandemic, according to a report published by the Employee Benefit Research Institute.

Using claims data from 2013 to 2021, researchers found that primary care office visits at a family/general practice, internal medicine practice or with a medical doctor dropped during that time. The share of visits with a nurse practitioner, however, increased significantly, from 4% in 2013 to 16% in 2021.