This is part of our Medicaid Concepts series, in which we provide a high level overview of key concepts in the Medicaid industry today.
What do we mean by telehealth?
Telehealth (in any payer space) can mean a wide variety of healthcare services that are technology-enabled, including:
- Remote patient monitoring
- Messaging
- Virtual provider visits
Until recent years, most telehealth services were delivered using a hub and spoke model, which essentially connected providers across locations for specialist consultations. In the traditional hub and spoke model, a patient still has to travel to a location for the telehealth visit. As smartphones and related applications have evolved, patients also want more ability to have services delivered virtually, and more options have emerged for members to stay at their home and receive telehealth services.
A large industry of solution vendors has emerged in recent years, and has been especially successful during the COVID pandemic. Significant investment dollars flow through to these vendors, and a corresponding increase in sales and marketing efforts has occurred.
What role does Medicaid play?
Medicaid programs have historically paid more for telehealth than other payers (or had more generous coverage). This is changing as other large payers (such as Medicare) have relaxed previous restrictions on telehealth coverage during the COVID pandemic. Each Medicaid program sets its own rules related to telehealth, and there are often state laws governing payments for telehealth. These laws usually focus on whether telehealth must be covered, and whether it must be paid for at rates similar to in person visits.
Some of the challenges Medicaid agencies face related to telehealth are:
- Determining which services can be delivered virtually and still meet HEDIS quality standards (which are used in pay for performance models)
- Determining which services can be delivered virtually and still meet HEDIS quality standards (which are used in pay for performance models)
- Determining which services can be delivered virtually and still meet HEDIS quality standards (which are used in pay for performance models)
- Determining which services can be delivered virtually and still meet HEDIS quality standards (which are used in pay for performance models)
Explore further
https://www.medicaid.gov/medicaid/benefits/telemedicine/index.html
https://www.cms.gov/Medicare/Medicare-General-Information/Telehealth
https://www.hhs.gov/coronavirus/telehealth/index.html
https://www.cms.gov/newsroom/fact-sheets/medicare-telemedicine-health-care-provider-fact-sheet
https://telehealth.hhs.gov/providers/billing-and-reimbursement/
https://www.cms.gov/Medicare/Medicare-General-Information/Telehealth/Telehealth-Codes