Specialty Telehealth Coverage Beyond COVID-19: Safer for Providers and Patients, Cost Effective for Payers

By Dr. Jonathan Wiesen

The societal changes and adaptations that we have witnessed in the last six months are nothing short of astounding.  Almost overnight, healthcare transitioned from brick and mortar to virtual interactions and digital health monitoring services.   The Centers for Disease Control and Prevention (CDC) advise that changes in the way that health care is delivered during this pandemic are needed to reduce staff exposure to ill persons, preserve personal protective equipment (PPE), and minimize the impact of huge patient volume surges on facilities. 

These adaptations were not limited to only the young, technology savvy populations.    More senior citizens than ever before have been using mobile platforms. Healthcare for the elderly is also being transformed to a virtual, home based enterprise:  a recent Advisory Board Study survey demonstrated that 75% of individuals over 60 years of age used a telehealth – related monitoring device routinely, and a recent study indicated that a majority of MA participants used telemedicine services during the COVID-19 pandemic, with over 90% satisfaction with the experience. 

Thanks to recent regulatory  changes during the COVID-19 pandemic, many barriers to telehealth access have been eased, promoting the use of telehealth as a way to deliver acute, chronic, primary and specialty care, support chronic care management, and improve patient outcomes. Many professional medical societies endorse telehealth services and provide guidance for medical practice in this evolving landscape.  In fact, many virtual clinical services and remote monitoring programs are now reimbursable by CMS.

Value Proposition for Specialty Telemedicine

The value of general telemedicine for MA plans is a foregone conclusion as evidenced by the extraordinary rate of adoption and utilization during the COVID-19 pandemic. It follows the path of general telemedicine – routine urgent or acute care consultations with on-call physicians – which has been demonstrated to be among the most cost-effective benefits in MA plans.  

A Government Accountability Office (GAO) report from early 2019 attributed MA savings of over $500 million to telemedicine services.  With massive attributable cost savings to telemedicine, the GAO report advocated establishing telemedicine services a routine benefit in MA programs and estimate that an allocation of almost $100 million to CMS’s Medicare Trust Fund will be delivered as a result.   

Cost savings attributed to telemedicine are over $200 per episode, according to a recent study published by Anthem.  The impressive cost savings demonstrated provided the impetus for expanding and encouraging telemedicine services among their MA plans, as they expect that greater engagement in telemedicine services will lead to significant savings.  Moreover, the study demonstrated fewer ancillary tests and unnecessary medications as compared with routine brick and mortar care for MA beneficiaries, without any decrement in outcomes.  

Specialty Telemedicine and Medicare Advantage: Post-COVID-19 Safety   

Undoubtedly, there is perhaps no more compelling benefit of telemedicine than patient and provider SAFETY, which has gained such importance during the COVID-19 pandemic.   Specialty telemedicine in particular has been hailed as an imperative for any and all healthcare services since it provides high quality care while still maintaining appropriate distancing measures, necessary to prevent viral transmission.  

This is particularly relevant for MA beneficiaries whose underlying comorbid medical conditions place them at high risk for severe COVID-19 sequelae, yet simultaneously also necessitate relatively frequent medical consultations.  Telemedicine enables physicians to manage elderly patients who require frequent interactions with their primary care provider, as well as their endocrinology and cardiology specialists, while maintaining safe distancing practices for all. 

Careful and thoughtful care of MA beneficiaries necessitates that all telemedicine, particularly specialty services, be utilized as often as possible to protect both patients and their caregivers.  After all, this is a population which requires the routine care of specialty physicians beyond the current crisis and telemedicine has demonstrated to be cost effective and appreciated with high satisfaction.

Specialty Telemedicine Addresses Specialty Provider Shortages 

Prior to the current pandemic, reports noted the shortage of at least 50,000 specialty providers in the United States.  Explanations for the shortfall include an uneven distribution of providers, a shortage of training facilities, and physicians departing clinical practice owing to burnout and early retirement.   This finding is not novel, with reports going back years documenting this trend.  The onset of the COVID-19 pandemic, and the subsequent closure of many primary and specialty care outpatient clinics, will likely exacerbate this deficiency.  

Specialty telemedicine levels the playing field and streamlines physician availability.  Physicians can remotely cover multiple locations at once, thereby increasing their accessibility to accept consultations.

Utilizing Telemedicine for Chronic Disease Management

An Association of Medical Colleges (AAMC) report in 2019 estimated a physician shortage in the United States of over 100,000 providers was estimated, distributed relatively evenly between primary and specialty doctors.  Compounding the challenge of the physician shortage is the increased burden of chronic medical conditions.  

For example, a Milken Institute report indicated that the U.S. health care costs for chronic diseases such as heart disease, cancer, diabetes, and Alzheimer’s disease totaled $1.1 trillion in 2016. When lost economic productivity is included, the total economic impact was $3.7 trillion. This is equivalent to nearly 20 percent of the U.S. gross domestic product.  

Current telemedicine initiatives have not targeted lowering the cost of this major driver of healthcare expenditures, and coaching and wellness programs lack crucial physician engagement and involvement necessary to manage more complex components of the diseases. In contrast, telemedicine and telehealth have been associated with improvements in patient’s HbA1c (17%, in over 50% of patients) and 70% improvement in cholesterol management.  Telemedicine was also associated with significantly decreased wait times and improved visit attendance for patients with chronic conditions.  This improved care led to 75% fewer hospitalizations and cost savings of $45,000 per patient per year.  

Telemedicine Beyond COVID-19

The remarkable clinical, cost-saving and patient satisfaction data, coupled by the safety profile of telemedicine in protecting patients and providers from COVID-19 infection, is driving adoption and increased utilization of virtual care.  The current pandemic environment simply sets the stage for accelerated reliance upon virtual care going forward. 

 Dr. Jonathan Wiesen, M.D., is founder and chief medical officer of MediOrbis.