The Washington, D.C.-based Better Medicare Alliance (BMA), an organization that advocates for Medicare Advantage plans and providers, on July 28 published a study on telehealth and COVID-19 that was conducted by the research firm ATI Advisory, and which was commissioned by the BMA’s new research arm, The Center for Innovation in Medicare Advantage (CIMA).
In a press release posted to its website on Tuesday, the BMA stated that “‘Telehealth During a Time of Crisis: Medicare Experiences Amid COVID-19’ analyzes Medicare Current Beneficiary Survey (MCBS) data and the results of nearly 20 interviews with high-level executives at Medicare Advantage plans, providers, telehealth vendors, and policy experts to identify factors accelerating the delivery of telehealth in the COVID-19 environment, and barriers to fulfilling its full potential.”
The press release stated that “The report found that Medicare Advantage’s risk-based structure allowed for faster adoption of telehealth services during the COVID-19 pandemic, noting that “Providers pointed to risk-bearing relationships with Medicare Advantage plans as a main driver in their ability to scale virtual care for Medicare patients … Providers also reported that Medicare Advantage capitated payments allowed them to implement and expand solutions without having to wait for fee-for-service policy waivers to ‘catch-up’ to Medicare Advantage.”
The press release noted that “Stakeholder interviews for this report revealed that one Medicare Advantage plan with existing telehealth infrastructure reported a four-fold increase in utilization. Another large Medicare Advantage plan reported loaning 50,000 tablets to members to allow access to telehealth using a clinical home monitoring program to deploy devices and services. Consistent with CMS data, these findings show that the Medicare Advantage-led transition to telehealth was particularly useful for behavioral health – which grew more than other services during the COVID-19 crisis and significantly reduced no-show rates for appointments. CMS reports that 60 percent of Medicare mental health services with psychologists and psychiatrists were provided through telehealth.”
The press release quoted Allyson Y. Schwartz, president and CEO of the Better Medicare Alliance, as stating that “Telehealth is here to stay – carrying with it the potential to improve health equity and bring the quality, affordable care found in Medicare Advantage to new, underserved, and rural populations. As this report shows, Medicare Advantage continues to lead the way in telehealth adoption – aided by a risk-based, value-driven framework that made for a faster transition to virtual care when the COVID-19 pandemic hit,” Schwartz said. “Plans and providers interviewed for this research believed strongly in the promise of telehealth for offering more convenient and accessible care for seniors in preventive services and ongoing care. Opening the option of telehealth to additional specialties was also beneficial. Patients, too, are experiencing its benefits, with a poll from May of this year showing a 91 percent telehealth favorability rating among Medicare Advantage beneficiaries.”
Schwartz continued, “Yet our report also calls out the barriers that still exist – from the lack of Internet access and usage that persist for many seniors, to limitations in Medicaid and Traditional Medicare that have an inhibiting effect on Medicare Advantage. The report goes further and offers specific solutions for reform. It shows that we can meet beneficiaries where they are by expanding the use of both video and audio-only telehealth – recognizing that audio-only telehealth is preferred by upwards of 60% of beneficiaries, according to multiple interviewees for this report. Further, providers and plans pointed out that problems remain if diagnoses obtained during audio-only telehealth visits are excluded form risk adjustment during this public health emergency. Our recommendations include the elimination of outdated limitations including originating site requirements, lifting restrictions on the type of providers eligible for telehealth services, and allowing the use of audio-only telehealth for risk adjustment in Medicare Advantage.”
The report noted that, “Amid a host of temporary waivers and flexibilities from the Centers for Medicare & Medicaid Services (CMS), telehealth usage has skyrocketed – increasing more than 12,000 percent from before the public health emergency to the end of April. The report identifies challenges that remain. For example, a full 34 percent of Medicare beneficiaries living below the Federal Poverty Line report no internet usage. Similarly, 33 percent of the eldest Medicare beneficiaries (85 and older) report no internet usage. Up to 50 percent of older Medicare beneficiaries are without cell phones, and a substantial portion are without Wi-Fi or internet at home – limiting opportunities for audio-video telehealth.”
The BMA report recommends that the following steps be taken:
Ø Updating provisions in the Social Security Act that inhibit the uptake of telehealth in Traditional Medicare and, therefore, Medicare Advantage such as: eliminating or expanding originating site requirements to better allow the use of telehealth in the home.
Ø Permanently expanding services allowed through modalities such as audio-based and asynchronous technologies. CMS should also identify services that are effectively provided with audio alone and align audio and video payment for these services to encourage efficient use and curb unnecessary growth in overall utilization.
Ø Modernizing the Medicare Advantage bid process so that plans are not limited to the exact telehealth services they specify in their bids six months in advance of a contract year. Flexibilities for modification prior to or during the contract year could encourage further innovation in telehealth.
Ø Updating Traditional Medicare’s payment approaches to promote appropriate growth in telehealth. This includes modifying Traditional Medicare’s fee schedules to reflect growing telehealth and virtual care delivery and ensuring that payment for telehealth is on par with in-person services as appropriate.
Ø Allowing virtually-informed risk adjustment with certain guardrails during the public health emergency.