Viewpoint: Telehealth Can Support Network Adequacy Requirements

Despite some risks, a group of healthcare researchers and leaders proposed in a Health Affairs article that telehealth should play a role in determining network adequacy as it could provide many advantages due to its growing use. 

As insured patients obtain healthcare, network adequacy plays a significant role. Network adequacy refers to health insurers' inclusion of care providers in their networks. There are standards around these set by federal, state, and self-insuring organizations.

Although factors such as the number of in-network specialists and primary care physicians are often the main proxy measures for access, their ability to accurately measure care access is often questioned. The reasons relate to the likely presence of inaccuracies, the lack of ability to guarantee provider availability, the limited availability of provider types, and little consideration of patient access factors.

Although the growth of telehealth would seemingly make access measurement more complex, the authors noted that evaluation of its place in network adequacy is needed. In fact, the authors noted their opinion that telehealth would support network adequacy requirements.

Aside from assisting with care delivery, the article noted multiple advantages that could derive from telehealth's inclusion into network adequacy requirements.

The addition of telehealth into network adequacy standards could alter how payers view it, making it a necessity rather than a burden. Researchers surmised that telehealth's efficacy in offsetting barriers to care would encourage investment in telehealth. 

Alongside this advantage, incorporating telehealth in network adequacy standards could lead to higher investments in in-person provider networks. This could occur following the likely changes telehealth would have on the definition of access, leading to changes in payer relationships with their networks.

"Telehealth’s ability to enable a more nuanced definition of access can allow payers to be held more accountable for their networks, potentially driving greater investment in in-person networks instead of driving payers out of markets where access may already be lacking," the authors wrote.

But telehealth's inclusion in network adequacy requirements also includes risks to be aware of, the authors noted. The most likely issues are the diminishing of in-person care investments and the rise of health inequities.

Further, steps to add telehealth into network adequacy standards may be lengthy.

The authors suggested that adding telehealth-specific outcome measurements can provide various benefits. Other steps include creating a universal language for telehealth and directing attention toward patient responses.

Additionally, the authors suggested using a phased approach to the implementation of telehealth in network adequacy requirements. Given the challenges surrounding policy changes, facilitators should continually evaluate the impact of this implementation.

As it becomes increasingly apparent that telehealth is earning a permanent place in healthcare, efforts to optimize its use are ongoing.

In October 2022, the Bipartisan Policy Center (BPC) aimed to support telehealth use and its efficacy through the release of a report that detailed Medicare usage trends, along with recommendations for policymakers.

The report shows that telehealth use among Medicare beneficiaries rose sharply during the COVID-19 pandemic. With the goal of gaining further insight into beneficiary activity, the BPC reviewed the relationship between telehealth and Medicare patients. The organization then addressed whether regulatory flexibilities should be continued and composed a set of recommendations for policy changes based on this data.