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Could the Private Payer Market Influence Post-COVID-19 Telehealth Coverage?

A new report from PHI’s Center for Connected Health Policy on telehealth coverage by private payers during the coronavirus pandemic found that most of the big health plans made major changes in coverage to help providers embrace telehealth. Their analysis suggests that even though most of these changes are temporary, these large health plans will alter the reimbursement landscape for telehealth beyond COVID-19.

  • mHealthIntelligence
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An analysis of telehealth coverage by private payers during the coronavirus pandemic finds that most of the big health plans made major changes in coverage to help providers embrace connected care.

The study by the Center for Connected Health Policy (CCHP) suggests that even though most of these changes are temporary, these large payers will alter the reimbursement landscape beyond the COVID-19 public health emergency to accommodate more virtual care services. And for an industry that covers roughly 68 percent of the American market, those strategies will be impactful.

The report concludes,

“These developments have presented private payers with a unique opportunity to reassess their telehealth coverage policies in light of utilization trends and consumer preferences prompted by COVID-19.”

Most of the big payers assessed in the report, including UnitedHealthcare, Anthem, Aetna, CIGNA, Humana, the Health Care Services Corporation (BCBS) and Kaiser Permanente/Foundation, waived cost-sharing for telehealth services and even extended those waivers to non-COVID-19 treatments, such as primary or urgent care and behavioral health visits. Almost all enacted payment parity, and four of the seven added limited coverage for out-of-network telehealth services.

All of these payers set expiration dates for this expanded coverage, some ending in 2020 and others in 2021.

That falls in line with emergency measures enacted by the federal government and many states to extend telehealth access and coverage during the pandemic. The CCHP report raises the question of how the private payer market, which is affected by state laws and often follows the lead of the Centers for Medicare & Medicaid Services (CMS), might shape its own telehealth policy going forward. The CCHP report noted,

“Initially, this report was intended to analyze private payer’s existing, pre-pandemic telehealth coverage policies without regard for temporary changes prompted by COVID-19. However, in conducting this research we recognized that many of the temporary changes introduced by private payers constitute enormous shifts in coverage from business as usual.”

Click below to read the full story in mHealthIntelligence.

Originally published by mHealthIntelligence


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