Insurers Urge CBO to Consider Their Data in Telemedicine Evaluations

Eleven private insurers are urging the Congressional Budget Office (CBO) to take the experience of commercial health insurers into account when evaluating the potential impact of telemedicine coverage on Medicare. As reported last week in Healthcare Informatics, representatives of some of the nation’s largest private insurers sent a public letter in October to CBO director Keith Hall asking the agency to make use of relevant data on telemedicine from commercial health insurers.

Representatives of Aetna, Anthem, Blue Cross Blue Shield of Tennessee, Cambia Health Solutions, CareSource, EmblemHealth, HMSA-Blue Cross Blue Shield of Hawaii, Horizon Blue Cross Blue Shield of New Jersey, Humana, Molina Healthcare, and MVP Health Care wrote, “We believe our experience in the commercial market can inform estimates of the impact of policy changes in Medicare.”

The October 18 letter stated that barriers in Medicare limit private insurers’ ability to offer telemedicine services to their Medicare Advantage (MA) customers. “We have worked closely with CMS [the Centers for Medicare & Medicaid Services] to find ways to provide telemedicine through MA plans, but can only do so as a supplemental benefit.”

“Our options are also limited without congressional action to reduce barriers in the Medicare fee-for-service benefit. Congressional action depends, in part, on a budget impact analysis from your office. We encourage the Congressional Budget Office to look to data available in our commercial programs and other public programs to assist in informing utilization and cost estimates when evaluating potential cost impacts of removing barriers to utilizing telemedicine in Medicare,” the insurers said.

They further stated, “As you know, actuaries in the insurance industry conduct careful analysis before coverage decisions are made. Available data supports the value proposition of telehealth and shows that there are significant savings to be gained even as it increases access to care.”

The letter said that one public actuarial study that examined data from five leading telemedicine platforms found that telehealth services results in savings:

Data from that study suggested that, on average, 83 percent of telehealth visits resolved the clinical issue for which care was being sought via telehealth, requiring no additional follow-up care. Patients therefore have no need to go to urgent care, the ER or the doctor’s office. We would be happy to facilitate a meeting between the appropriate CBO staff and representatives from our organizations to discuss our experiences with telehealth and share outcomes data we have seen to date in our commercial insurance programs.

The insurers note that a number of government entities have moved toward greater inclusion of telemedicine in publicly funded healthcare. CMS has allowed or included coverage of telemedicine in their new payment models. Congress included telemedicine in clinical improvement activities as part of the Medicare Access and CHIP Reauthorization Act (MACRA). Medicaid agencies, the Department of Defense, and the Veterans Administration are all adopting telemedicine services.

A press release issued by Cambia Health Solutions and quoted in the Healthcare Informatics article describes the catch-22 inherent in the current situation: “Legislation in Congress must be evaluated by the CBO, but because of the restrictions on telemedicine usage in Medicare, there is limited Medicare data.”

In recognition of the critical need to provide CBO with more data on telehealth, CTeL convened a working group earlier this year tasked with gathering data on telehealth practices that reduce the cost of care. Leveraging CTeL’s relationships with members of Congress from both sides of the aisle, the CTeL Working Group plans to present its findings to the Congressional Budget Office (CBO) via members of Congress. On November 17, attendees at the Fall 2016 CTeL Telehealth Summit will get an update on the working group’s efforts in the session “Expanding Telehealth Reimbursement: Making the Case to the CBO.”

Click here to read the letter insurers sent to the CBO via a link at Fierce Markets.

Click here to read the full article at Healthcare Informatics.


Leave a Reply