Employer Purchasers Mull Virtual-First Plans, Virtual Primary Care

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.


How Will Interstate Telehealth Licensure Waivers’ Expiration Impact Medicare Beneficiaries?

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%.


With Elections Coming, Chances for Telehealth Reform Dwindle

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.


Studies: Telehealth Ups Low-Income Members’ Care Access

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.”


Demand for Medication Abortion May Rise if Roe Falls

The use of medication abortion — which involves two drugs, mifepristone and misoprostol — has grown significantly since its approval and now accounts for 54% of all pregnancy terminations before nine weeks of gestation in the U.S. If the Supreme Court overturns Roe v. Wade, medication abortion usage is likely to increase as patients in states that ban the procedure are likely to attempt to obtain courses of medication abortion from states that allow it. Only 18 states and the District of Columbia allow both advanced practice clinicians and medical doctors to dispense abortion pills. Six states have passed laws banning any use of telehealth for medication abortion, according to a recent Kaiser Family Foundation analysis. Insurance coverage for both surgical and medical abortion is heavily regulated across the nation. A 2019 study from the Government Accountability Office found that 14 states’ Medicaid programs do not cover mifepristone even in the cases of rape, incest and life endangerment.


Telehealth Usage Expands by Over 7,000% During the Pandemic

Driven by the COVID-19 pandemic, telehealth utilization increased 7,060% from 2019 to 2020, while utilization dropped 38% in ambulatory surgery centers, 30% in emergency rooms, 16% in urgent care centers and 4% in retail clinics, according to a new FAIR Health white paper. The FH Medical Price Index tracks the weighted average growth in median procedure charges and median allowed amounts. Among the six procedure categories it studied, hospital evaluation and management saw the largest percent increase in both the charge amount index and allowed amount index.


Patients Love Telehealth, but Could Doctors Dislike It?

Virtual care has become a mature industry during the COVID-19 pandemic, with insurers and investors pouring money into telehealth startups. But the telehealth boom has changed how practitioners deliver care in ways that they don’t necessarily like, according to a new survey from McKinsey & Co. Though telehealth is here to stay, much remains unsettled about the way physicians use virtual care tools — and how they are paid to do so.

Nearly every physician now uses telehealth, according to McKinsey, and the change happened fast: 83% of physicians that the consulting firm surveyed in 2021 offered virtual services, versus 13% in 2019. The survey also found that by May 2021, 88% of consumers had used virtual care since the start of the pandemic.


AHIP Will Prioritize Telemedicine, Health Equity Post-Pandemic

On Feb. 23, health insurer trade group AHIP hosted a virtual State of the Industry presentation, reviewing progress made in 2021 and important issues for the health insurance industry as it looks to a world beyond the COVID-19 pandemic.

Matt Eyles, president and CEO of AHIP, opened the conversation with a look at the organization’s 2021 initiatives and hopes for 2022. Eyles stressed the importance of the No Surprises Act, which aims to protect consumers from surprise medical bills. The legislation went into effect on Jan. 1, but it is currently the subject of a number of lawsuits filed by organizations including the American Hospital Association and American Medical Association. “AHIP continues to fight and protect the law,” Eyles said during the presentation.


New York Medicaid Insurer Hopes Virtual Care Will Boost Access

MVP Health Care has launched a new virtual care offering for its New York Medicaid members that allows them to connect with primary care and specialty care physicians through an app made by the digital health company Galileo. Kimberly Kilby, M.D., the insurer’s vice president and medical director of health and well-being, and Christopher Del Vecchio, president and CEO of MVP Health Care, tell AIS Health that they want the new partnership to improve health equity for the insurer’s Medicaid beneficiaries.

The new partnership with Galileo is part of a multiyear effort at MVP to address an unmet need for virtual care. “Over the last 18 months, nearly 40% of MVP’s Medicaid members have not seen a primary care physician (PCP), often due to competing demands on time and resources such as transportation and language barriers,” Del Vecchio tells AIS Health, a division of MMIT, via email.


News Briefs: Rhode Island Subpoenas UnitedHealth Over Data Breach

Rhode Island Attorney General Peter Neronha, a Democrat, subpoenaed UnitedHealthcare over a recent data breach that saw the personal data of 22,000 plan beneficiaries get hacked by an unknown third party. The exposed beneficiaries were members of the health plan of the Rhode Island Public Transport Authority, which discovered the breach, Modern Healthcare reported.

The number of telehealth visits has declined as the pandemic has receded, according to analysis of Epic Systems Corp. data by the Kaiser Family Foundation. The research indicates telehealth visits accounted for 13% of outpatient visits between March and August 2020, but declined to 11% of outpatient visits between September 2020 and February 2021 and 8% of such visits from March to August.