Implicit in the government’s decision to allow Medicare Advantage plans to cover telehealth services with federal dollars is a question: Just because insurance plans legally can do it, will they?
At least in the early going, multiple providers of telehealth tech to skilled nursing operators have said yes — and the promise of plan savings seems to back it up.
The Centers for Medicare & Medicaid Services (CMS) last week finalized a plan that will see telemedicine move from an optional add-on to a core benefit for plan year 2020. Whereas in the past, Medicare Advantage insurers had to budget for telehealth coverage out of their own money, plans can now directly use federal funds to pay for the interventions.
“With these new telehealth benefits, Medicare Advantage enrollees will be able to access the latest technology and have greater access to telehealth,” CMS administrator Seema Verma said in a statement. “By providing greater flexibility to Medicare Advantage plans, beneficiaries can receive more benefits, at lower costs and better quality.”
That subtle shift has telehealth providers excited about the possibilities.
“The Medicare Advantage telehealth benefits are a welcome development that will resonate across the SNF sector,” Paul Cristiano, CEO of the Avon, Conn.-based TeleCare Partners Group, told SNN.
Cristiano, whose company’s clients include Saber Healthcare, described the current state of long-term care as a “burning platform that demands change,” pointing to ongoing increases in the senior population and an overall shortage of doctors in the elder care space.
For Call9, a telemedicine platform that connects SNF providers with emergency remote interventions, CEO and founder Timothy Peck believes that the move will bring more consistency when working with Medicare Advantage partners. In the past, insurance executives were frequently excited about the prospect of covering nursing home interventions during meetings with Call9 leaders, Peck said — but that didn’t always trickle down to the contractors responsible for forging partnerships on the ground level.
“As a provider, contracting for MA services, the people on the ground who you contract with have had their hands tied, have had handcuffs on them to be able to move fast or work with providers like ourselves,” Peck said.
Part of that mental barrier came from the financial pressures of not including telehealth as a basic benefit: Under the old model, plans had to find the extra money to cover remote health services, essentially putting them on the hook for any potential losses. That required providers like Call9 to do extra legwork to show that their services can save money and improve care, convincing employees from top to bottom that their technology were worth betting on.
“I don’t think we’ll have to do that that much anymore,” Peck said. “We’ll just be able to go straight to the people who contract, and it’ll just be part of the job.”
That isn’t to say that telemedicine hasn’t been proven to save providers and the government money. Call9, which already works with a variety of Medicare Advantage plans including Anthem and Blue Cross Blue Shield, demonstrated that its tech helped one facility prevent 70% of residents who used Call9 from returning to the hospital over a nine-month span.
Third Eye Health, a Chicago-based telehealth platform that serves 20,000 patients in around 200 SNFs, has been able to reduce hospital readmission rates at facilities from 20% to the low teens — a significant decline in an era when both hospitals and SNFs can receive financial penalties for failing to lower acute-care admissions from post-acute settings.
Third Eye vice president of growth and strategy Ray George told SNN that he’s hopeful Medicare Advantage plans will move quickly to expand their coverage of telehealth in SNFs.
“We have seen firsthand how access to a licensed physician in just a matter of minutes has a meaningful impact on clinical outcomes,” George said. “This includes reducing unnecessary hospital readmissions, adding timely access to physicians for care decisions, and increasing access to acute-level care while in the SNF.”
Peck noted that such interventions could solve a recently publicized problem in skilled nursing: The fact that residents didn’t see a doctor at all in 10.4% of all nursing home visits between 2012 and 2014, as reported in a recent study from the journal Health Affairs.
“You need ways to get physicians in-house to the nursing home,” he said. “Well, now telemedicine is your way. It’s an obvious way to get it done.”
The Medicare Advantage expansion has also brought hope that CMS will bring complete telehealth benefits to traditional fee-for-service Medicare, which currently only covers the tech in rural nursing homes — or about a third of the nation’s 15,000 facilities. Peck specifically is optimistic about the RUSH Act, a piece of federal legislation with bipartisan support that would cement telehealth SNF care for Medicare residents regardless of location.
“I think RUSH will take care of that, and then you’ll have the whole population of Medicare and Medicare Advantage getting covered by value-based plans, having access to physicians,” Peck said. “Together, they work in concert.”
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