Payers Push Congress to Expand Medicare Telemedicine
Eleven of the US’ largest commercial health insurance companies will share their experience and garnered data on improved care access and cost saving measures with the Congressional Budget Office. The information will underline the value of telemedicine and aid federal actuaries currently considering the cost of expanding Medicare’s remote coverage. The health insurers have said in a letter to the Congressional Budget Office that their experience in the commercial market could help to inform the policy changes, which are currently being considered as telemedicine in Medicare is currently only available in a very specific set of circumstances. The companies cited one actuarial study that strongly suggests that telehealth saves money, with 83% of telehealth visits resolving healthcare issues and eliminating the need for follow-up care in urgent care, the ER or the doctor’s office.

Eleven of the nation's largest commercial plans offer to share their data and experience on cost-savings and improved access to care with the Congressional Budget Office, as Congress crafts legislation to expand telemedicine within Medicare.

Commercial health insurance companies are offering to share their data on the value of telemedicine to federal actuaries who are estimating the cost of expanding remote coverage under Medicare.

"We view telemedicine as an important tool in increasing consumer access to high quality, affordable healthcare, improving patient satisfaction and reducing costs" 11 commercial payers said in a letter this week to Congressional Budget Office Director Keith Hall. "We believe our experience in the commercial market can inform estimates of the impact of policy changes in Medicare."

Telemedicine in Medicare is reimbursable only on under a narrow set of circumstances, but Congress is examining ways to expand it. Any legislation to expand Medicare telemedicine that comes with a price tag attached will require scoring by the CBO, which has limited experience in estimating the value and cost of telemedicine because of the federal government's limited exposure.

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Because of that, the commercial payers say their data could provide a clearer picture of the effects of telemedicine on access to care, health outcomes and budgetary impacts.

"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 payers wrote.

The payers cited one actuarial study that examined data from five telemedicine platforms found that telehealth services save money. "The data suggests that, on average, 83% 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," the payers told Hall.

The 11 insurers are: 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.