telehealth

A new behavioral health venture that sprung from an innovative Horizon Blue Cross Blue Shield of New Jersey initiative is focused on embedding its integrated approach within other health plans and provider groups. NovaWell, a Horizon affiliate that launched Nov. 14, is offering a suite of technology-forward solutions aimed at tackling the country’s ongoing mental health crisis. Jolted into the public consciousness by the COVID-19 pandemic, the crisis is characterized by rising rates of anxiety and depression amid a shortage of trained professionals.

Backed by more than five years of testing and program design aimed at addressing the behavioral health needs of Horizon’s members, the NovaWell suite brings an integrated care management approach supported by network-enhancing solutions to a wider audience. Two of the company’s four core offerings, a fully integrated clinical model called NovaClinical and a network solution known as NovaNetwork, are positioned to bolster health plans, Suzanne Kunis, president and CEO of NovaWell, tells AIS Health, a division of MMIT.

A recent survey from UnitedHealthcare found that 71% of respondents said they would likely use virtual care in the future, up from 53% in last year’s survey. Donna O’Shea, M.D., UnitedHealth’s chief medical officer of population health, tells AIS Health that the results indicate the use of virtual care is more than just a COVID-19-specific trend and is likely to become a permanent part of health care.

Still, that’s not to say that people prefer virtual care over visiting doctors in their offices. In fact, the 2022 UnitedHealthcare Consumer Sentiment Survey found that 60% of respondents preferred in-person appointments for non-emergency issues such as allergies, flu or rashes, while 26% preferred virtual appointments and 14% had no preference. The question assumed that the quality and costs of care were comparable between in-person and virtual settings.

Amid a global pandemic and inflation challenges, CEOs surveyed for a recent report expressed confidence in the three-year outlook for their companies and the economy. While many respondents from the life sciences sector said they expect a recession will occur within the next year, almost the same amount said their growth prospects are strong, according to the KPMG 2022 CEO Outlook. Those CEOs also expressed a growing interest in environmental, social, and governance (ESG); and diversity, equity and inclusion (DEI) initiatives.

For the eighth edition of the report, KPMG spoke with 1,325 CEOs from 11 markets around the globe and 11 key industry sectors, including life sciences, between July 12 and Aug. 24. The company shared the responses from the life sciences CEOs on their three-year outlook with AIS Health, a division of MMIT.

Billing for remote patient monitoring (RPM) jumped by more than four times during the first year of the pandemic, according to a recent Health Affairs study. The increase was mostly driven by a handful of primary care providers. Using medical claims data from the OptumLabs Data Warehouse collected between Jan. 1, 2019 to March 31, 2021, the researchers found that there were 19,762 general RPM claims in March 2021, compared with 4,355 claims in February 2020. Continuous glucose monitoring, however, only saw a slight increase over the same period of time.

In addition, RPM claims were highly concentrated. The top 0.1% of primary care providers — identified by the researchers as “high-volume provider group” — accounted for 69% of all general RPM claims.

During the early stages of the COVID-19 pandemic, states moved to temporarily allow health care providers licensed in other states to practice in their own jurisdictions with the goal of addressing staffing shortages and increasing access to telehealth. Many in the managed care industry have hoped that these short-term reforms would become permanent, with the goal of cutting costs and preserving telehealth access, but health policy experts are just beginning to make sense of the impact interstate licensure had during the early pandemic. 

Reforms to telehealth and insulin pricing are stalled in Congress despite notable progress on health care policies like enhanced marketplace subsidies in recent days. D.C. insiders tell AIS Health, a division of MMIT, that comprehensive fixes to either issue are unlikely to make their way into the landmark Inflation Reduction Act of 2022 (IRA), which seems poised to pass the Senate.

Telehealth reforms have passed the House of Representatives, but insiders tell AIS Health that they are unlikely to pass the Senate. They are also not expected to be included as part of a final version of the IRA, which should emerge in the coming days. Some insulin reforms may be included in the IRA, but D.C. experts expect that reforms affecting the commercial market are unlikely to pass as part of the bill. Instead, the insulin price changes are likely to be restricted to Medicare.

More purchasers than ever are offering virtual primary care to their members and may be on the verge of launching “virtual-first” plans, according to recent surveys by benefits consultants and brokers. However, health care experts tell AIS Health, a division of MMIT, that there’s an important distinction between the availability of such options to members and actual uptake — and point out purchasers aren’t yet convinced that virtual offerings will reduce costs or improve the member experience.

Recent benefit surveys show increasing interest from employer purchasers in the availability of virtual primary care — which places a member with a telehealth primary care provider inside a traditional health benefit — and virtual-first plans, which are benefit designs that require members to use some sort of telehealth option (usually a telehealth PCP) as their primary point of contact with the health care system.

During the pandemic, all 50 states and Washington, D.C., issued licensure waivers that allowed out-of-state clinicians to perform telehealth with patients across state lines. By analyzing telehealth usage by Medicare beneficiaries from 2017 to 2020, researchers found that out-of-state telehealth made up only a small percentage of all outpatient visits during the first year of the pandemic, though the percentage varied by state, according to a recent study published in Health Affairs.

The number of out-of-state telehealth services jumped from 17,286 in the first quarter to 171,754 in the second quarter of 2020, and then slightly declined. Before 2020, less than 1% of out-of-state new patient visits occurred via telehealth nationwide, while in 2020, the number jumped to 6%.

Despite a pressing need to revise telehealth laws to match the new, post-pandemic expectations of patients, payers and providers, D.C. insiders tell AIS Health, a division of MMIT, that Congress may not actually pass legislation on the issue. With Congress preoccupied by the midterm elections and the possible revival of the Biden administration’s signature Build Back Better Act (BBBA), chances for standalone legislation on telehealth are slipping away.

That doesn’t mean that Congress won’t address telehealth regulations. But telehealth reforms will likely have to pass as part of a larger piece of legislation. That’s how the No Surprises Act, which banned surprise billing, finally made its way through Congress.

Several new studies have found that telehealth flexibilities introduced during the COVID-19 pandemic increased access to care for patients who would otherwise struggle to get it. However, the same researchers say that telehealth can’t solve health care disparities on its own — and that lots of work needs to be done to make sure that the incremental improvements made possible by improved telehealth access are durable.

A study published in the May edition of the journal Health Affairs by researchers from Johns Hopkins University found that Medicare patients “living in the most deprived neighborhoods had the highest rates of telemedicine use….Overall, our findings are encouraging, as they suggest that the Medicare telemedicine coverage waiver could improve access to health care for people in the most disadvantaged US neighborhoods without worsening disparities.”