The first rule in writing a blog is to be willing and able to respond to events as they happen. To that end, I will not talk about mobile devices this month, but rather on what I believe is a significant change in the financing of payments for telemedicine services.
It has become apparent over the past three months that there is a tidal sea change in the way health plans and health insurers are viewing telemedicine.
There are significant parallels with the rise of retail clinics a decade ago and how telemedicine is similarly being viewed by insurers today. In 2000, very few health insurance plans would cover the cost of a retail clinic visit. As of 2012, most if not all plans have some retail clinic reimbursement model that is oftentimes designed to help reduce overall healthcare costs by driving non-emergent clinical consultations away from the emergency room to a more cost-appropriate setting.
Furthermore, in the last 12-24 months, several states including Virginia and Pennsylvania have passed legislation requiring both public and private health insurers to cover telemedicine and telehealth services at an equal or similar rate as in-person services. During the same timeframe, Medicare has significantly expanded coverage for telehealth services. Many more states have similar bills in process.
Beyond state-based initiatives, the Affordable Care Act specifically addresses telemedicine/telehealth as part of the solution of controlling costs and delivering quality care in medicine.
Why is this meaningful? As the chief medical officer of Consult A Doctor, I have been privy to several meetings and conversations with health plans across the country over the past few months regarding the addition of our telemedicine service to their network plans. It is apparent that the “tipping point” has been reached with acknowledgement of the value, quality and cost containment possibilities of telemedicine.
Now that telemedicine is considered a viable clinical encounter with reimbursement methods, its rapid expansion into the daily clinical lives of physicians, nurses, hospitals, therapists and other health occupations is imminent. Jumping from a novelty to a practical daily clinical tool, telemedicine now has the opportunity to fulfill the promises that its proponents have been talking about for nearly a decade such as offering greater access to care in a more cost-efficient setting, all while improving clinical outcomes.
With nearly 200 million Americans covered by private health insurance and another nearly 50 million covered by some sort of government plan1, telemedicine is poised to take a very substantial role in the delivery of health care for a large part of the population over the next 12-36 months. As an industry veteran who has been extremely involved in the acceptance and growth of an innovate care delivery model, it is clear to me that all we can do now is hold on for the ride!
1) 2010 U.S. Census