Vermont Workgroup Outlines Long-Term Coverage for Audio-Only Telehealth

A workgroup of payers, providers and others in Vermont is recommending that the state continue coverage of audio-only telehealth services beyond the coronavirus pandemic.

In a 114-page report to state officials, the group recommended continuing commercial insurance and Medicaid coverage for audio-only services beyond the state of emergency, noting that underserved residents in the Green Mountain State face several barriers to access healthcare, including inadequate broadband connectivity and little means to purchase the necessary technology.

“Audio-only telemedicine has provided Vermonters access to their healthcare under COVID-19, and outside of a pandemic response, has the ability to support the continuity of care for individuals that face barriers to accessing their healthcare through traditional telemedicine and in-person visits,” the Vermont Program for Quality in Health Care wrote in a separate report included in this study.

“The workgroup recognizes that audio-only telemedicine is not a silver bullet for achieving equitable access to health care, but does recognize it as a step in the right direction under the current conditions of our healthcare delivery system of fee-for-service payments, and in a world where the digital divide exists,” that report continues. “It is imperative we use every tool available to ensure patients get a measure of care where they need it, when they need it, as we simultaneously bridge from where we are currently as a delivery system, to where we want to be.”

The workgroup stressed that audio-only phone calls should be covered only when the service is medically necessary and clinically appropriate, and when access to in-person or audio-visual services is unavailable.

Telehealth advocates have long argued that audio-only phone services should be covered in some limited fashion for people who don’t have the resources to access audio-visual telemedicine platforms. The COVID-19 crisis made that argument more timely, with healthcare providers looking to shift as many services as possible away from in-person care and onto connected health platforms.

With the pandemic still in play, the federal government and many state governments have issued a number of emergency declarations expanding telehealth access and coverage during the public health emergency – including providing coverage for audio-only services. Some states, such as Massachusetts, New Hampshire and Colorado, have moved to some of those measures permanent.

The Vermont workgroup was brought together by the Department of Financial Regulation last year to develop recommendations for long-term telehealth coverage after the emergency ends. Called the Vermont Statewide Telehealth Workgroup, it pulled together data and studies from several sources, including the Vermont Program for Quality in Health Care. 

Based on that data, the workgroup offered seven recommendations:

1. Address the digital health divide, including broadband access and digital literacy gaps;
2. Mandate coverage for audio-only phone services beyond the PHE;
3. Require informed patient consent for audio-only services;
4. Make sure those services adhere to the same standards of care as for other platforms;
5. Ensure that healthcare providers are properly trained on delivering care through audio-only channels;
6. Standardize the definitions of “telehealth” and “telemedicine” so that commercial health insurers and the state’s Medicaid program are talking the same language; and
7. Reimburse providers for using audio-only telehealth on a fee-for-service bases for two years beyond the PHE, then shift to a value-based, prospective or capitated payment system.

The workgroup noted that reimbursement issue was the one issue in which it couldn’t come to a consensus, as some members felt that coverage should be less than that for in-person care and others felt that payment parity should be put in place.

In its report, the Vermont Program for Quality in Health Care concluded that establishing a reimbursement plan for a phone call iusn't as easy as it sounds, and will likely involve more study.

“The workgroup recognizes that missteps in care delivery can occur with any type of encounter, and there is currently a lack of research surrounding the sensitivity of utilization, appropriateness, outcomes, and cost, stratified by clinical condition, health care setting, and telehealth modality,” the group said. “Our proposed framework for ensuring quality care is delivered by audio-only telemedicine, and patient safety is safeguarded, aligns with the basic tenants of continuous quality improvement. This is with the caveat that continuous quality improvement is an iterative process, and adaptations will need to be made, and tested, as new research is carried out and best practices are identified.”