As CMS Seeks to Advance Virtual Care: 46% of Medicare Advantage Plan Members Unsure if Plan Offers Telemedicine, another 37% Say it is Not Offered: HealthMine Survey

DALLAS, Aug. 7, 2018 /PRNewswire/ -- The proposed 2019 Medicare Physician Fee Schedule and Quality Payment Program, unveiled by the Centers for Medicare & Medicaid Services (CMS) in July 2018, includes expanding Medicare-covered telehealth services to include prolonged preventive services.  While coverage of telehealth services is expanding, a survey of 781 Medicare Advantage members shows that few Medicare Advantage members are aware if their plan offers or recommends online and phone-based telehealth services.  The survey results revealed that 46 percent were unsure if their plan offers telehealth, 37 percent said it is not offered, and 17 percent noted it is offered.  The HealthMine Medicare Survey queried 781 insured age 65+ consumers with a chronic condition who are enrolled in a Medicare Advantage and/or Supplemental plan.

According to a CMS press release issued on July 12, 2018 announcing the proposed program, CMS Administrator Seema Verma said, "CMS is committed to modernizing the Medicare program by leveraging technologies, such as audio/video applications or patient-facing health portals, that will help beneficiaries access high-quality services in a convenient manner."

The agency acknowledged in its press release that "getting to the doctor can be a challenge for some beneficiaries, whether they live in rural or urban areas. Innovative technology that enables remote services can expand access to care and create more opportunities for patients to access personalized care management as well as connect with their physicians quickly.

Provisions in the proposed CY 2019 Physician Fee Schedule would support access to care using telecommunications technology by:

• Paying clinicians for virtual check-ins – brief, non-face-to-face appointments via communications technology;
• Paying clinicians for evaluation of patient-submitted photos; and
• Expanding Medicare-covered telehealth services to include prolonged preventive services."

The HealthMine survey also revealed that 77 percent of respondents use a smart device (a smartphone or tablet).  All the respondents were computer literate as the survey was fielded online.

According to a February 2018 Telehealth Reimbursement report by CENTER FOR CONNECTED HEALTH POLICY, The Federally Designated National Telehealth Policy Resource Center:

"Medicare advantage plans will start being able to provide coverage for additional telehealth benefits (beyond those already covered under Medicare Part B) beginning in plan year 2020. Those benefits would include services available under part B, but ineligible for payment due to the restrictions around telehealth currently in Medicare and those that are identified as clinically appropriate. Th­e Secretary is required to solicit comments on the types of telehealth services that should be considered additional telehealth benefits by November 30, 2018, and once implemented enrollees will have discretion as to whether or not to receive those services through an in-person visit or telehealth."

As we await comments, huge potential costs savings were reported.  "Cowen and Co. analyst Charles Rhyee estimates the average cost of a telehealth call is between $40-$50 compared to around $150 for an urgent care visit, and nearly $1,500 for a trip to the emergency room.

Rhyee also estimates that roughly $135 billion of Medicare's annual $675 billion in spending could be done by telehealth."

According to Bryce Williams president and CEO of HealthMine, "For Medicare Advantage plans, telehealth seems to be a perfect storm to lower cost.  First, awareness of telehealth will only grow with better diagnostics.  Second, there are 10,000 baby boomers per day becoming Medicare eligible, which means that we will have more beneficiaries who are technologically proficient.  And, finally, CMS is taking steps to expand Medicare-covered telehealth services to include prolonged preventive services.  The smart Medicare Advantage plans are already educating members how, when and where to use telehealth.  A $40-$50 telehealth visit, versus an in-person visit for a routine procedure, could mean millions in savings for a plan.  And, it will add up to billions in savings for overall Medicare."

HealthMine also queried Medicare members in 2017 and found that 57 percent of Medicare plan members were unsure whether their plan offered telemedicine, and another 31 percent said it was not offered, with 14 percent saying it was offered. 

About the Survey
The HealthMine Medicare Survey queried 781 insured age 65+ consumers with a chronic condition who are enrolled in a Medicare Advantage and/or Supplemental plan. The survey was fielded by Survey Sampling International (SSI) in June/July 2018. Data were collected via an opt-in panel. The margin of error was three percent (3%). Survey Sampling International (SSI) has been the Worldwide Leader in Survey Sampling and Data Collection Solutions, across every mode, for more than forty years.

About HealthMine
HealthMine is the only member-centric clinical technology company with a platform built inside a Value-Based Insurance Design (VBID) health plan. It is specifically designed to identify risks earlier and close gaps in care faster. The HealthMine solution consists of Automatic Health, a clinical analytics platform, that generates insights and recommendations. It includes Opportunity Manager, an application that gives plans continuous access to data, insights, and recommended interventions generated by the clinical analytics platform, prioritized by projected revenue and cost savings opportunities and the Personal Health Assistant consumer application that empowers plan members to manage their health. HealthMine is on the web at www.healthmine.com.

SOURCE HealthMine

Related Links

https://www.healthmine.com