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The world looks entirely different since COVID-19 landed here in the U.S. last year. From months of quarantine mandates causing job losses to shortages of toilet paper, everyday life seemed to turn on its head. Today, people are still wearing masks, many businesses are still only operating at half capacity, and we all have a newfound appreciation for hand sanitizer.Another significant shift affecting Americans is the way in which people engage their healthcare providers. Born out of necessity, telehealth became a lifesaving way for consumers to connect with their doctors, address health concerns, and refill prescriptions without visiting the doctor’s office. It was safer for many to avoid crowded waiting rooms due to the potential increased exposure to the virus. And for Americans living in more rural areas, telehealth was the only option. The data is rolling in now regarding those telehealth participation numbers.

As the data unveils, many are wondering how this increased trend will impact other industry segments. What improvements can insurance providers and healthcare professionals expect to see? And more importantly, what challenges can the industry as a whole expect to face as a result of this influx of virtual health?

What Is Telehealth & Telemedicine?

Telehealth isn’t just a video call with a physician. Telehealth, also referred to as telemedicine, is any connection with a healthcare provider that isn’t an in-person visit. So, providers who can evaluate, consult, and diagnose patients by phone, app, video, or other electronic conferencing means, are engaging in telehealth.

The CDC describes telehealth beyond the doctor-patient engagement. Telehealth is also available in medical facility settings where nurses and assistants can examine on-site patients electronically and virtually, as well. Patient monitoring qualifies, from another room in the facility, and is especially important if the risks are too great to provide care in person. But the CDC also suggests telehealth can be real-time, via recorded messages, and even document exchanges.

There are countless benefits to telehealth, including the protection of the patient and healthcare workers. But telehealth also provides more access to healthcare for those who can’t or won’t see a professional in person. Here are a few examples of traditional in-person visits that are now seeing more telehealth engagements:

  • Physicals and checkups with physicians
  • Screenings for certain conditions, including COVID-19
  • Post-hospitalization follow-up
  • Care and support for chronic health issues, including weight management and nutrition
  • Therapy sessions with mental health practitioners
  • Non-emergency care checkups for long-term care facility patients

Wait, How Many People Used Telehealth Services Last Year?

Much of the country originally shuttered for more than six months. While consumers were still encouraged to venture out of their homes for necessary visits, including groceries and medications, most people felt confined to their corners of the world as a safety precaution. Doctors were postponing elective and less-than-urgent surgeries, too. But sheltering in place didn’t prevent people from connecting with their healthcare professionals. As technology adapted, more virtual options became available, and telehealth services became a new normal.

Telehealth usage last October alone increased by over 3,000% when compared to October of 2019. More than 51% of those October telehealth visits were mental health condition-related, according to FAIR Health. Using a regional tracker to collect these telehealth stats, Fair Health followed the data as visits tallied based on filed insurance claims. And right now, roughly three out of every four hospitals connect with patients remotely via chat, email, audio, and video channels.

During the emergency declaration periods, CMS rushed to add roughly 135 different services to the approved Medicare telehealth services roster. It also expanded the various types of medical providers allowed to offer telemedicine. Before the pandemic, estimates suggested nearly 14,000 patients were engaging in virtual visits in any given week. But between March and July of last year, more than 10.1 million patients reported receiving a telehealth service.

Since we first heard the news of COVID-19 last year, the telehealth surge overall jumped from 5.07% usage to 13% usage, according to the number of private insurance claims reported. And with that surge came a host of new challenges for insurance providers and health plans.

The Uptick in Telehealth Means New Definitions All-Around

Before insurance providers can pay or authorize payment for services, they first need to categorize and code each service for eligibility. Traditional definitions changed, allowing for remote services. And insurance providers expanded how they code and bill for telehealth visits.

Due to the pandemic and the public health emergency declarations that followed, telehealth was encouraged and, in some cases, mandated by the government. Doctors and other healthcare providers were authorized to engage remotely with patients whenever possible as of March 6, 2020. 

Coinsurance and deductibles would still be applicable for these types of visits. But many insurance providers extended discounts or waived charges altogether for some telehealth visits. And those with Medicare Advantage Plans or Medicare saw increased telehealth options that received additional approvals for 2021 coverage plans, as well.

States Defining Their Own

One of the challenges facing the healthcare industry and its host of support businesses during the telehealth boom is inconsistency. State laws, for example, are still staggered nationwide. While all 50 states mandate health insurance coverage for live video telemedicine engagements, only 21 states offer reimbursement for virtual patient monitoring.

And the states vary additionally in terms of authorizing the healthcare professionals who engage in telehealth visits. For example, some require the physicians to be licensed in the originating state, while others require licensing based on the patients’ locations. The medical boards are also regulating the types of technology required in each state, as well. For instance, in Connecticut or Maine, only video constitutes an official telehealth visit. There, a phone call doesn’t meet the board’s minimum requirements for a telemedicine visit.

A Need for More Technology and Better Guidelines

Telehealth will continue to be a viable option for patients and healthcare providers. But for the insurance providers that pay for these visits, more standardized guidelines will likely be needed. Many industry experts are pushing for government coordination with major health insurance providers. Standard definitions would simplify eligibility requirements nationwide. And many suggest better technology, hardware, and payment services are also needed to streamline the efficiencies.

This need presents ongoing opportunities for those businesses currently supporting digital functions within the healthcare ecosystem. If your company supports or connects to telehealth visits, you might be able to leverage some of the increased demand in a new direction. If you need a digital partner to explore your options in this market, contact us! We can help you face and power what comes next in this ever-evolving industry.

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