UnitedHealth exec on telehealth use, reimbursement: 'The genie is out of the bottle'

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Whatever hurdles might've held back the industry in the past, the COVID-19 pandemic has forced payers, providers and patients to simultaneously adapt to a new way of doing things, said Donna O'Shea, M.D., chief medical officer of population health management for UnitedHealthcare, during a FierceHealthPayer event. (UnitedHealthcare)

Telehealth companies have struggled for years to convince payers to reimburse for their services—and then to convince consumers to use the virtual healthcare offerings.

But whatever hurdles might've held back the industry in the past, the COVID-19 pandemic has forced payers, providers and patients to simultaneously adapt to a new way of doing things, said Donna O'Shea, M.D., chief medical officer of population health management for UnitedHealthcare.

"For UnitedHealthcare, I believe the genie is out of the bottle," O'Shea said during a virtual FierceHealthPayer event called Telehealth's Tipping Point hosted Tuesday.

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"Our members and your patients are going to want to continue to have access to their providers through telehealth," O'Shea said. "I think national providers for 24/7 urgent care is going to be considered standard. It already was considered standard, but with the recent McKinsey study showing that 20% of emergency department visits could have been handled virtually, I think that’s going to be another pull on the system."

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While health systems like Nemours Children's Health System have seen consumer expectations rapidly shift in many instances to prefer telehealth over in-person visits, health providers are closely watching to see how the Centers for Medicare & Medicaid Services (CMS) and private payers will pay for these services long term.

"I’m hopeful around reimbursement," said Carey Officer, operational vice president of Nemours CareConnect and Center for Health Delivery Innovation at Nemours Children’s Health System. "One of the critical hurdles we’re overcoming right now … is that they’re extending those waivers to reimburse for telehealth through the summer. One of the things we were really concerned about when this started was that 90-day period. We were nervous we would need to continue to leverage telehealth to operate safely within our organization, to practice social distancing."

But how long those reimbursement changes will continue remains an open question.

UnitedHealthcare wants providers to continue to deliver telehealth but will need to follow some state regulations and CMS' lead with Medicare in order to make it work, O'Shea said.

"Of course, we’d love all the waivers, everything to stay in place. Use whatever you need to do to have telehealth and we’ll pay for that visit. A visit is a visit," O'Shea said.

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She said she thinks providers will need to move to HIPAA-compliant technology despite the waiver allowing providers to use non-HIPAA compliant technology right now.

"So we are encouraging our provider groups that have been offering virtual visits—and we do cover virtual visits through non-HIPAA compliant technology right now thanks to the CMS waiver—but we are encouraging our provider groups to get HIPAA compliant technology," O'Shea said. "I believe that will be important as we go forward and providers who don’t have that are going to miss out."

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