Could the Private Payer Market Influence Post-COVID-19 Telehealth Coverage?

An analysis of telehealth coverage by private payers during the coronavirus pandemic finds that most of the big health plans made major changes in coverage to help providers embrace connected care.

The study by the Center for Connected Health Policy CCHP), part of the 14-member National Consortium of Telehealth Resource Centers, suggests that even though most of these changes are temporary, these large payers will alter the reimbursement landscape beyond the COVID-19 public health emergency to accommodate more virtual care services. And for an industry that covers roughly 68 percent of the American market, those strategies will be impactful.

“These developments have presented private payers with a unique opportunity to reassess their telehealth coverage policies in light of utilization trends and consumer preferences prompted by COVID-19,” the report concludes.

CCHP, which covers national telehealth policy and regulations and issues a number of reports each year, targeted seven of the largest health plans for this report: UnitedHealthcare, Anthem, Aetna, CIGNA, Humana, the Health Care Services Corporation (BCBS) and Kaiser Permanente/Foundation. In a review of policies implemented up to Nov. 25, 2020, it found that all seven voluntarily expanded coverage for their commercial health plans to meet challenges created by COVID-19.

In particular, most of the big payers waived cost-sharing for telehealth services and even extended those waivers to non-COVID-19 treatments, such as primary or urgent care and behavioral health visits. Almost all enacted payment parity, and four of the seven added limited coverage for out-of-network telehealth services.

All of these payers set expiration dates for this expanded coverage, some ending with 2020 and others sometimes during or the end of 2021.

That falls in line with emergency measures enacted by the federal government and many states to extend telehealth access and coverage during the pandemic. Some states have moved to make some or all of their measures permanent, extending telehealth coverage beyond the crisis, while others are waiting on Congress to set post-COVID-19 telehealth policy.

The CCHP report raises the question of how the private payer market, which is affected by state laws and often follows the lead of the Centers for Medicare & Medicaid Services (CMS), might shape its own telehealth policy going forward. This may be driven by how these payers see telehealth being used during the pandemic – and it may give health systems, hospitals and other providers more reason for charting their success with connected health.

“Initially, this report was intended to analyze private payer’s existing, pre-pandemic telehealth coverage policies without regard for temporary changes prompted by COVID-19,” the report noted. “However, in conducting this research we recognized that many of the temporary changes introduced by private payers constitute enormous shifts in coverage from business as usual.”

How that plays out in long-term private payer telehealth coverage remains to be seen.

The challenge lies in moving from temporary telehealth freedoms to a long-term telehealth policy, an effort that hasn’t been clear-cut with either the federal government or the private payer market. And without that clear direction, many health systems will scale back or even discontinue telehealth services for fear of losing coverage. In this economy, they can’t afford to wait things out.