Insurers to CBO: Help remove telemedicine barriers in Medicare

Doc and computer

Major health insurers say current regulations impede their ability to offer telemedicine benefits to their Medicare Advantage beneficiaries, and they want the Congressional Budget Office (CBO) to come to their aid.

In a recent letter, Aetna, Anthem, Humana, Molina Healthcare, MVP Health Care, EmblemHealth, Cambia Health Solutions, CareSource and three Blue Cross Blue Shield plans make the case for the CBO to conduct an analysis of the budget implications of removing telemedicine barriers in Medicare.

In July, the Centers for Medicare & Medicaid Services’ annual Medicare Physician Fee Schedule proposed adding several codes to the list of telemedicine services eligible for reimbursement, including services for end-stage renal disease related to dialysis, advance care planning and critical care consultations.

The insurers say they have worked closely with CMS to provide telemedicine in MA plans, but currently can only do so as a supplemental benefit. And the required congressional action to reduce barriers in the Medicare fee-for-service benefit depends, in part, upon an analysis from the CBO.

To conduct such an analysis, the CBO should examine data available in the insurers’ commercial programs to help it estimate telemedicine utilization and cost, the letter says. For example, a 2014 study that examined data from five leading telemedicine platforms found that on average, 83 percent of telehealth visits resolved the issue for which care was being sought, eliminating the need for an emergency department or urgent care visit.

Telemedicine also furthers patient engagement, expanded access to care, population health management and care coordination, the letter adds.

“We believe that in its role as a payer, Medicare, too, could see similar outcomes and improved access and care for millions of our nation’s seniors and people with disabilities,” the insurers write.

Private insurers have increasingly embraced telemedicine in recent years through partnerships with major providers like Teladoc and American Well, and Kaiser Permanente has been a particularly strong proponent of the concept. In addition, nearly every state provides some degree of Medicaid reimbursement for telehealth services.

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