Insurers to CBO: Consider Private Insurers’ Data in Evaluations of Telemedicine

Oct. 26, 2016
Eleven private insurers, including Aetna, Humana and Anthem, are urging the Congressional Budget Office (CBO) to consider the experience of commercial insurers when evaluating the impact of telemedicine coverage in Medicare.

Eleven private insurers, including Aetna, Humana and Anthem, are urging the Congressional Budget Office (CBO), in a public letter to CBO director Keith Hall, to consider the experience of commercial insurers when evaluating the impact of telemedicine coverage in Medicare.

In the letter sent last week, the representatives of Aetna, Anthem, Blue Cross Blue Shield of Tennessee, Cambia Health Solutions, CareSource, EmblemHealth, HMSA-Blue Cross Blue Shield of Hawaii, Horizon Blue Cross Blue Shield of New Jersey, Humana, Molina Healthcare and MVP Health Care, noted that there is significant congressional interest in breaking down barriers to telemedicine access in Medicare. “We believe our experience in the commercial market can inform estimates of the impact of policy changes in Medicare,” the insurers wrote.

“We view telemedicine as an important tool in increasing consumer access to high quality, affordable healthcare, improving patient satisfaction and reducing cost. Given recent advances in technology, telemedicine gives customers a new way to be more engaged in their care, and save time and money. Additionally, telemedicine contributes to the value-based care goals of patient engagement, expanded hours for primary care, population health management and care coordination,” the insurance companies stated in the letter.

In a press release about the letter, representatives of Cambia Health Solutions further wrote, “Telemedicine is only permitted in Medicare under a very narrow set of circumstances, but there is a major bi-partisan effort to change the law and expand access. Legislation in Congress must be evaluated by the CBO, but because of the restrictions on telemedicine usage in Medicare, there is limited Medicare data. In light of this lack of data, the CBO should consider the effects that telemedicine’s expansion in the commercial market has had on access, health outcomes, and costs when estimating the budgetary effects of making telemedicine benefits in Medicare commensurate with the rest of the American healthcare system.”

The commercial insurers point out in the letter that CMS has allowed or included coverage of telemedicine in their new payment models, and Congress included telemedicine in clinical improvement activities as part of the Medicare Access and CHIP Reauthorization Act. Additionally, other public payers such as state Medicaid agencies, the Department of Defense and the Veterans Administration are adopting telemedicine services.

“As you know, actuaries in the insurance industry conduct careful analysis before coverage decisions are made. Available data supports the value proposition of telehealth and shows that there are significant savings to be gained even as it increases access to care,” the commercial insurers stated in the letter.

The company leaders also stated that one public actuarial study that examined data from five leading telemedicine platforms found that telehealth services results in savings.

“Data from that study suggested that, on average, 83 percent of telehealth visits resolved the clinical issue for which care was being sought via telehealth, requiring no additional follow-up care. Patients therefore have no need to go to urgent care, the ER or the doctor’s office. We would be happy to facilitate a meeting between the appropriate CBO staff and representatives from our organizations to discuss our experiences with telehealth and share outcomes data we have seen to date in our commercial insurance programs,” the letter stated.

The commercial insurers also state that the barriers in Medicare hamper the ability to offer telemedicine services to Medicare Advantage customers.

“We have worked closely with CMS to find ways to provide telemedicine through MA plans, but can only do so as a supplemental benefit. Our options are also limited without congressional action to reduce barriers in the Medicare fee-for-service benefit. Congressional action depends, in part, on a budget impact analysis from your office. We encourage the Congressional Budget Office to look to data available in our commercial programs and other public programs to assist in informing utilization and cost estimates when evaluating potential cost impacts of removing barriers to utilizing telemedicine in Medicare,” the insurers stated in the letter.

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