TELEHEALTH’S BIG PITCH

Telehealth makes its big pitch

Up next: An all-out push to cement gains made under COVID

BY KARA HARTNETT

elehealth has been a buzzword in the

T industry for years — and has seemingly had its progress thwarted for about that long by restrictive regulations and a relative lack of insurance coverage. COVID-19 appears to have changed all that in the space of a few weeks.  e technology got to  ex its capabilities at scale throughout the pandemic, and providers collected data and invested in infrastructure they plan to leverage in future negotiations with insurers and lawmakers as they seek to make telehealth’s dramatic expansion permanent.  e rapid shift to relying on virtual solutions as people isolated in their homes forced the industry to break through multiple barriers that had long held back telehealth’s growth. Greater access to the internet, looser government regulations and broader insurance reimbursements were key factors in the success of the massive ramp-up of telehealth in March. What had formerly seemed like a pipe dream to many in the sector — or at best a mighty long slog — has quickly exploded into a comprehensive delivery platform where spending is predicted to reach $250 billion this year.

“We were able to accomplish more in two months than we had accomplished in  ve years,” Vanderbilt University Medical Center telehealth director Amber Humphrey says.

As soon as the Centers for Medicare and Medicaid Services committed in mid-March to reimbursing telehealth visits at the same rate as in-person visits, many private insurers followed suit. Other government agencies also loosened restrictive protocols to allow providers some breathing room during the pandemic, paving the way for patients to connect with their doctors without running the risk of contracting COVID-19.

On their end, many doctors and other providers jumped on the opportunity and shifted resources to providing virtual medicine where they could, enabling them to stay connected to their patients and monitor their physical and mental health over a phone or computer — and bringing in at least some revenue that otherwise would have been lost entirely.

Humphrey and her team at VUMC were able to mobilize their existing telehealth platform from hosting a mere 10 visits per day to handling more than 2,000 per day across primary care, pediatrics, behavioral health and specialties. Humphrey says only 160 doctors in the system’s network were using telehealth prior to March. By June — and after hosting nearly 3,300 training sessions — more than 1,700 providers and hundreds of sta were on board.  e nonpro t medical center also took advantage of loosened state licensure regulations to access out-of-state markets that were formerly unreachable. Humphrey says several doctors have under emergency statutes been granted temporary licenses for bordering states and will likely seek permanent licensing there once regular rules fall back into place.

Thinking about next steps Having hosted more than 100,000 telehealth visits in less than three months, Humphrey says her team is now working to compile data and patient satisfaction surveys to pitch more permanent changes to lawmakers and insurance companies. Vanderbilt has been working for three years to enhance telehealth coverage in the state legislature, partnering with certain lawmakers to encourage payers to begin including full telehealth coverage in their benets packages. Carriers have in the past voiced concerns about the potential overutilization of telehealth, but Humphrey says she hopes negotiations will be dierent this time.

“Instead of just saying, ‘We would like to do this,’ now we can show them the data from their patients,” she says. “We can show the satisfaction. We will have real cost information. So I think it will be a more meaningful conversation.”

Contracts Vanderbilt currently has with four commercial payers that have yet to commit to covering telehealth permanently — Aetna, Cigna, Humana and United, who combined make up a quarter of VUMC’s payer mix — will end within two years. BlueCross BlueShield of Tennessee, Vanderbilt’s largest private payer by far, was one of the rst non-government plans to oer free telehealth coverage to its members in March, and committed to continuing covering telehealth permanently by May. e Center for Medicare and Medicaid Services has made the same commitment. e chances seem good that VUMC and other providers will nd a more receptive audience when insurer contracts come up for renewal. e trade group America’s Health Insurance Plans signed on to a letter sent in March to Vice President Mike Pence and Congressional leaders calling for steps to preserve/ expand access to care, including telehealth. e organization has since voiced support for longer-term measures that expand access and in early June published a blog post, written by two ocials at DentaQuest, that called for lasting changes to telehealth policies to build on the wave of COVID-related moves.

“is trend will have a lasting inuence on consumers, who already want faster, more affordable, and more convenient health encounters, and can be the basis for securing more supportive policies and greater awareness about the types, tools, and benets and barriers to telehealth,” the DentaQuest executives wrote.

Other players also are invested — and investing — in expanding telehealth’s reach. e U.S. Department of Health and Human Services has pumped millions of dollars into nationwide pilot programs that have built out technology infrastructures and tracked treatments’ ecacy. Meharry Medical College, the country’s oldest historically black medical college and landlord to Nashville’s safety-net hospital, received $719,000 to expand a telehealth program that monitors people with chronic illnesses such as blood pressure, diabetes, lung disease and heart disease. Many of those patients are low-income and don’t have reliable access to the internet that would let them connect virtually with their doctors. Meharry is using the federal funds to buy tablets, hotspots and accessories patients can take home to stay connected and monitor their vital information through bluetooth attachments. e remainder of the HHS grant will build out the medical school’s internal capabilities with the aim of launching a program that can monitor up to 1,000 patients with chronic illness. Dr. Duane Smoot, senior associate dean for clinical aairs at Meharry, says the disparities on display during the current public health crisis — black Americans are disproportionately more likely to die from COVID — underline the need to distribute technology that can help bring more health equity to underserved populations.

“e problems that many of the chronic diseases that African Americans have is what is putting them at higher risk for morbidity or death,” Smoot says. “So we need to better manage the chronic illnesses of our patients by providing these devices in their home and be able to monitor them weekly.”

Prior to the pandemic disrupting most economic activity, Smoot says Meharry was providing telehealth services at most one day a week. By May, he says, nearly one-third of its overall visits were through an online platform. To continue making this work possible, Smoot and others say the state legislature needs to expand existing telehealth regulations to allow patients’ homes to be originating sites. Without a public health emergency distorting the system and leading to a loosening of regulations, Tennessee has one of the most restrictive

‘We can show the satisfaction. We will have real cost information. So I think it will be a more meaningful conversation.’

AMBER HUMPHREY, VUMC

policies on telehealth: Providers can’t be paid at normal rates if patients participate in their care from their homes.

“Direct-to-patient is the game changer,” Bob Vero, regional CEO for Centerstone in Tennessee says. “Telehealth before required the patient to travel to a licensed oce. So here we are trying to increase access to people — and it did — but if you were a recipient of care, you had to get in the car and show up at a clinic so that one of our providers, no matter where they were, could deliver a service to you. at changed with this increased exibility. Direct-to-patient is making all the dierence.”

Centerstone, a Nashville-based mental and behavioral health provider, transitioned nearly 5,000 of its sta members in ve states and 90 percent of its care visits to virtual venues within a week, according to Vero. e organization is now providing nearly 2,500 telehealth visits per day thanks to the addition of 500 laptops and new reimbursement policies.

’We’ve taken away a lot of the reasons people don’t follow through with their care.’

BOB VERO, CENTERSTONE

Vero says the ecacy of telehealth in behavioral and mental health settings is proving itself through the pandemic: Centerstone patients have been showing up to appointments with 30 percent more frequency, and health outcomes have been equivalent to in-patient sessions.

“Across the board, people are saying that no-show appointments have dropped. e kept rate for therapy has increased dramatically because we can reach people more easily and because they are more likely to keep that appointment,” he says. “We’ve taken away a lot of the reasons people don’t follow through with their care.”

Now, Vero says it’s up to insurers. With many more consumers having been exposed to a new, simpler way to stay connected to their health care, he believes telehealth is seeing a new day that will cement its place in care delivery models.

“We need other insurers like BlueCross BlueShield to step forward and recognize that this has been a real benet to their members, and that they are committed to member choice,” Vero says. “at’s the way we really need to start seeing this. Let’s make sure that as we enter into this new era of health care delivery, patient choice includes telehealth where it’s appropriate.”

S A V E T H E D A T E

09.16.20

Touching stories, light-hearted anecdotes and hardwon wisdom: This luncheon featuring a panel discussion among some of the city’s top female leaders — which the Nashville Post hosts in conjunction with our colleagues at Nfocus — will leave you buzzing and inspired.