telehealth

News Briefs: Cigna Tucks In a New Telehealth Asset

The Cigna Group’s Evernorth division said on Oct. 10 that it acquired Bright.md, which provides “asynchronous care, triage, and health care navigation services.” The new acquisition’s capabilities will be added to Evernorth’s existing telehealth platform, MDLIVE, starting in 2024, the company said. Once the two telehealth offerings are combined, patients seeking care will be guided through a “digital clinical interview” that is then converted into a comprehensive chart note — rather than going immediately to a real-time clinician interaction. A clinician then will review the patient’s responses and offer a diagnosis, care plan or prescription, or the patient will be connected “to a different modality or setting for care when clinically appropriate.” Evernorth noted that “this asynchronous care experience is not based on artificial intelligence or machine learning, and all care decisions are made by clinicians.” Additionally, MDLIVE will expand its chronic care management to include health coaching.

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News Briefs: Wyden, Pallone Probe Medicaid Prior Authorization Denials

Prominent Democratic lawmakers have launched an investigation following an HHS Office of Inspector General (OIG) report citing high rates of prior authorization denials by Medicaid managed care organizations. That report, which reviewed 2019 claims data from seven multistate MCOs, found that those insurers denied 12.5% of all prior authorization requests — more than double the denial rate of Medicare Advantage plans that same year. Alarmed by the report, House Energy and Commerce Committee Ranking Member Frank Pallone, Jr. (D-N.J.) and Senate Finance Committee Chair Ron Wyden (D-Ore.) said they sent letters seeking information about prior authorization practices to CVS Health Corp.’s Aetna, AmeriHealth Caritas, CareSource, Centene Corp., Elevance Health, Inc., Molina Healthcare, Inc., and UnitedHealthcare. Among other questions, the lawmakers want “a description of all algorithms, including machine learning and artificial intelligence algorithms” that the companies use when considering prior authorization requests.

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Researchers Take Closer Look at Virtual Mental Health Care Boom

Now that the COVID-19 public health emergency has ended, the health care system — including insurers — are grappling with how to proceed in the “new normal” amid shifted habits and utilization patterns. To that end, two new studies offer insights into the implications of patients’ growing use of telehealth for mental health care services.

“The COVID-19 pandemic has caused massive amounts of changes in health care delivery, but then also in terms of how individuals are dealing with the pandemic. There’s been extensive research about how anxiety has increased or [how] other mental health disorders have increased,” observes Jonathan Cantor, Ph.D., a policy researcher at RAND Corp. With that in mind, Cantor and his fellow researchers sought to build on a previous study and measure how both telehealth and in-person mental health utilization and spending has changed from 2019 to 2022.

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Large Employers Worry Over Worsening Worker Mental Health, Drug Costs

When asked about the COVID-19 pandemic’s impact on their employees’ health and well-being, a whopping 77% of employers surveyed by the Business Group on Health said they are currently seeing increased mental health issues in their workforce. And based on other findings in the employer coalition’s annual survey, companies are counting on their health plan partners to help them address this growing issue.

According to Business Group on Health Vice President Brenna Shebel, “77% is a stark jump over last year,” when 44% of employers said they were seeing an uptick in conditions such as substance use disorders, depression and anxiety. This year, another 16% of employers said they anticipate seeing an increase in mental health issues in their workforces in the future, “so certainly a key finding here is the dire need for mental health services and supporting their employees as they’re navigating their myriad needs in the area of mental health,” Shebel added during an Aug. 22 virtual press event held to present Business Group on Health’s findings.

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News Briefs: Uninsured Rate Hit Record Low in March

In March, the national uninsured rate hit an all-time low of 7.7%, according to new data from the Centers for Disease Control and Prevention. Citi analyst Jason Cassorla wrote in an Aug. 3 investor note that the low rate “is not surprising” since Medicaid continuous enrollment provisions enacted during the pandemic were still in effect at that time – as were enhanced Affordable Care Act marketplace subsidies and the “generally stable to improving employment rate.” However, now that states have been permitted to restart Medicaid eligibility checks, the uninsured rate is almost certain to go back up, he pointed out.

Amazon.com., Inc. is expanding its virtual care offering, Amazon Clinic, to all 50 states and the District of Columbia. “In addition to message-based consultations in 34 states, Amazon Clinic now supports video visits nationwide,” the retail giant said in an Aug. 1 press release. Amazon first rolled out Amazon Clinic last November, but it was not available in all states at that time. Customers using the Amazon Clinic can access services via the Amazon website or mobile app, where they can “compare response times and prices from multiple telehealth provider groups, complete an intake form, and connect with their chosen provider,” the release stated. Patients do not need insurance to access the Amazon Clinic’s services and it doesn’t accept insurance; but the release noted that “medication prescribed by clinicians may be covered by insurance.”

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By Making More Telehealth Free, UnitedHealth Hopes to Curb Unneeded ER Visits

UnitedHealthcare will remove out-of-pocket costs and deductibles for remote urgent-care visits, effectively making them free for 5 million members in fully insured employer plans.

The goal is to remove financial barriers that prevent members from getting necessary acute care while deterring them from costlier settings like the emergency room, Donna O’Shea, M.D., chief medical officer of population health for UnitedHealthcare, tells AIS Health, a division of MMIT.

UnitedHealthcare’s effort to steer patients away from the ER is not new — but its $0 copay telehealth visits represent more of a consumer-friendly strategy than it has previously employed. In 2021, the insurer walked back a proposed policy that generated considerable outrage: It would have led to denials of some ER claims that were deemed non-emergencies after the fact.

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Highmark Tailors ‘Big Blue Box’ to Meet MA Members’ Evolving Needs

In the first year of the COVID-19 pandemic, when many people were having trouble accessing basic personal protective equipment, Highmark Blue Cross Blue Shield began sending out care kits including PPE and other items to support seniors at home. The response from Medicare Advantage members was so positive that what started out as a feel-good gesture has become a full-blown supplemental benefit, and the insurer continues to refine the kits to meet members’ evolving needs and ensure continued satisfaction with the plan.

Starting with plan year 2022, eligible Highmark members were given the option to receive one of 17 condition care kits. Commonly referred to as the “big blue box,” each kit is filled with a variety of items tailored to a specific condition, with a focus on member choice and high quality, speakers from Highmark and its strategic partner RR Donnelley explained during the 14th Annual Medicare Market Innovations Forum, held on March 28 and 29 in Orlando. RR Donnelley, a firm that provides marketing and business communications, commercial printing, and related services, has assisted CVS Health Corp.'s Aetna and Humana Inc. with similar initiatives.

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Though Remote Patient Monitoring Use Spikes, Barriers to Uptake Still Exist

The use of remote patient monitoring skyrocketed during the COVID-19 public health emergency, with RPM claims volume jumping by 1,294% from January 2019 to November 2022, according to a report released by Definitive Healthcare.

Since 2018, CMS added five new reimbursement codes for RPM services, and introduced five codes related to remote therapeutic monitoring in 2022. By November 2022, RPM claims volumes were already 27% higher than they were during 2021.

Internal medicine physicians were more likely to use RPM, with 28.7% of their procedure claims related to RPM. Cardiological and family practice providers ranked second and third at 21.3% and 19.4%. An analysis of diagnosis categories suggested similar trends. Essential hypertension saw the highest share of RPM-related claims at 51.0%, followed by diabetes mellitus with complications (10.4%) and diabetes mellitus without complications (6.4%).

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Remote Monitoring Faces Coding Challenges After Public Health Emergency Ends

Federal remote monitoring regulations tied to the COVID public health emergency (PHE) are expiring soon, and insurers and providers must make sure that remote monitoring is being used effectively and in compliance with permanent regulations. Health care experts say that payers and providers have an opportunity to improve clinical outcomes and increase value by applying pandemic-era lessons learned and best practices to ongoing remote monitoring-assisted care. 

Remote patient monitoring became a vital tool for practitioners during the COVID-19 pandemic’s darkest days. Hospitals were overwhelmed and, in many places, barred from providing elective services, creating an urgent need for “hospital-at-home” care. The Biden and Trump administrations facilitated expanded use of remote monitoring technologies through emergency regulations tied to the duration of the PHE, but it is set to end on May 11. In particular, hundreds of emergency use authorizations (EUAs) from the FDA will expire unless they have undergone a review process. Going forward, some reimbursement codes set up by CMS during the pandemic will be phased out, and others will carry on until the agency can set up permanent protocols.  

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Employers’ Desire to Shake Up Benefits Vendors Can Be Opportunity for Insurers

Although U.S. employers already contract with a bevy of health and wellbeing vendors, a recent survey found that nearly nine in 10 are planning to make changes to their vendor partnerships in the next two years — chiefly by adding or enhancing current offerings. As companies do so, health insurers have a critical role to play when it comes to integrating various solutions and helping employees find them, an employee benefits expert says.

Employers’ desire to add and enhance health/wellbeing offerings “doesn’t look like it’s going to stop anytime soon,” says Regina Ihrke, senior director and health, equity and wellbeing leader at WTW. Therefore, large medical benefits carriers “are going to have to continue to be nimble and flexible in who they partner with, and then how they also integrate with other carveout solutions that are out there,” she tells AIS Health, a division of MMIT.

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