Investor Appetite for Post-Pandemic Telehealth: Opportunities from the Medicaid and Commercial Insurance Markets – MedCity News

Investor interest in telehealth has increased during the COVID-19 pandemic. As the healthcare industry widely adopts telehealth, it is driven by necessity due to social distancing practices. Such expansion would not have been possible had the federal and state governments not waived many of the legal and regulatory requirements that had previously impeded the growth of telehealth. Many of these waivers are temporary and linked to public health emergencies (PHE), which may have already occurred or will expire soon. On the other hand, the amount of telehealth investment has already begun to decline. In fact, 2023 is expected to be the lowest year for telehealth funding since 2019. What this calls into question is a slowdown in telehealth investment due to tight credit markets and a slowdown. expected economic Or should the telehealth industry expect a downward trend in investor interest? Continuing in a post-PHE world?

A review of federal, state, and private payer activity indicates that interest in telehealth remains strong, thus, as credit markets stabilize and recession fears begin to subside. We expect investor interest in telehealth to return.

Background on pandemic telehealth coverage policies

Even before the Covid-19 pandemic, payers had created many policy and coverage barriers. This serves to limit the widespread adoption of telehealth services. For example, Medicare has a provision that prevents patients from receiving telehealth services from their homes. This includes limiting the frequency of certain telehealth services. Many state Medicaid programs and private payers have similar telehealth restrictions. On January 31, 2020, PHE was first announced at the federal level. According to PHE, the Department of Health and Human Services and the Centers for Medicare and Medicaid Services (CMS) have waived key telehealth requirements. Several aspects of Medicare have previously limited the widespread adoption of telehealth, with state Medicaid programs and private payers quickly following CMS compliance.

Insights into telehealth benefits from federal, state, and private payer operations.

The federal telehealth waiver expires when the federal PHE expires on May 11, 2023, although CMS is encouraged to continue expanding telehealth coverage. But many restrictions on telehealth are established by law, so Congress needs to act to make permanent policy changes. Under heavy industry pressure, on December 29, 2022, Congress temporarily extended many of the telehealth flexibilities that PHE provided to Medicare beneficiaries through December 31, 2024, given the deadlock in Congress. at present Legislative efforts to codify further expansion of telehealth coverage are therefore unlikely. It will be revisited until the end of 2024, although budget pressures may still lead to a temporary rather than permanent extension. With support from CMS, industry, and the public, Congress is unlikely to force a return to the pre-pandemic world of telehealth.

When considering coverage States will likely follow Medicare’s lead, however, with expectations that Congress will not take further action on telehealth solutions until late 2024, state action will provide useful insight into Strengths of the telehealth industry after PHE

Many state Medicaid programs offer more generous telehealth coverage policies. This has continued to widen over the past few years. States have long since lifted geographic restrictions placed on telehealth locations. In fact, Hawaii, Montana, and Maryland are the only state Medicaid programs that continue to limit reimbursable telehealth services to rural areas. In addition, 37 state Medicaid programs and Washington, D.C., allow them. Providing patients with telehealth services in their own homes Lifting geographic restrictions and expanding the categories of eligible places of origin. It means more patients. including previously disadvantaged populations Can access telehealth services

As for how telehealth services are delivered, all state Medicaid programs reimburse for live video, and 36 state Medicaid programs and Washington, D.C., also reimburse for audio-only telehealth services. Twenty-eight state Medicaid programs will reimburse for asynchronous telehealth services. Also known as store-and-forward policy. This allows providers and patients to share information directly with each other before and after telehealth appointments. State Medicaid program moves beyond past live video requirements Provides compensation opportunities for telehealth and technology providers. The success of the program could also lead to additional adoption of Medicare collection and forwarding services. (This is covered by Medicare only in Hawaii and Alaska. as part of the telehealth demonstration project)

States have also taken additional legislative action to address private payer reimbursement for telehealth services. Most states have passed Service Parity laws, requiring telehealth services to be covered. If you are not covered if you provide the service yourself Pay equity laws, which 24 states have passed Require that telehealth services be reimbursed at the same rate as in-person services.

In addition to flexible telehealth policies provided by state Medicaid programs, states are demonstrating their commitment to telehealth services by announcing their own investments in telehealth services. For example, the Minnesota Department of Health released a report in June 2023 detailing how telehealth services are helping to fill gaps in healthcare access and availability. Other states, such as Ohio and New Mexico, Broadband access is being expanded to remove technological barriers to accessing telehealth. Ohio is focusing its efforts on expanding broadband to provide telehealth access to K-12 students, and Governor Grisham of New Mexico recently announced that part of the federal funding Valued at 675 million US dollars to expand broadband access across the state will be earmarked to improve access to telehealth services. In March 2023, Governor Roy Cooper of North Carolina released a $1 billion investment plan to address the mental health and substance use crisis. of the state, including $225 million to increase Medicaid reimbursement rates for behavioral health services and allocating $50 million to facilitate access to mental health. treatment, including through telehealth, for rural communities

Private payer operations also offer valuable insights into the strengths of the telehealth market post-PHE, although private payers will always have flexibility in determining coverage for telehealth services. far (To the extent required by law.) Their newly added partnerships and services demonstrate their commitment to coverage and reimbursement for telehealth services. For example, BlueCross BlueShield of Massachusetts has expanded Mental Health Provider Network recently expanded its mental health network. Including telehealth partnerships with Headway and Talkiatry (and increasing sequential mental health spending from $610 million in 2019 to $1.3 billion in 2022), Aetna gives members access to CVS Health. Virtual Primary Care, which expanded this year to include telehealth care appointments with licensed therapists and psychiatrists. Similarly, Humana continues to develop its telehealth platform with the addition of Array Behavioral Care in February 2022 and Valera Health in July 2023 as providers to its network.


This is despite the end of PHE and the loss of many exemptions and policies that have facilitated greater adoption of telehealth during the pandemic. Recent actions by state governments and private payers indicate that interest in telehealth remains high. Therefore, we expect investor interest in telehealth providers and technology to remain similarly strong as the economic downturn approaches.

Photo: elenabs, Getty Images

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