Alliance News

This past week was big for telemedicine in public programs.  Both telehealth and remote patient monitoring (RPM) are proven tools in the commercial marketplace, but reimbursement restrictions have made adoption in Medicare and Medicaid pretty close to non-existent.  It is still essential to pass legislation to fix outdated legal barriers in these programs.  However, the Center for Medicare and Medicaid Services (CMS) created opportunities this week to demonstrate how valuable telehealth and RPM can be to the health care of millions of seniors and low-income Americans.

In the commercial market, telehealth is used for convenience and after-hours care that can substitute for more expensive and time consuming in-person options.  To date, RPM has largely been used to avoid hospital re-admissions and improve chronic disease management.  The new rules and programs released by CMS open the door to showing how these tools can help achieve the important goals of patient engagement, care coordination, expanded access to care and population health management driven by primary care providers.

Door #1: Comprehensive Primary Care + model (CPC+). This alternative payment model is aimed at supporting primary care practitioners in delivering “advanced” primary care. It is a multi-payer initiative that will impact up to 3.5 million Medicare FFS beneficiaries, as well as millions of other Medicare Advantage, Medicaid, and commercial patients.

Primary care practitioners will be paid a non-visit based, risk-adjusted per beneficiary per month (PBPM) care management fee to help ensure services are “accessible, responsive to an individual’s preference, and patients can take advantage of enhanced in-person hours and 24/7 telephone or electronic access.”

Practices must also ensure that care is “coordinated across the health care system,” patients receive “timely” follow-up after emergency room or hospital visits and that care is “patient-centered.” Telemedicine achieves all of these goals. Since primary care practices will receive a care management fee, they have flexibility on where they can make their investments. That funding won’t be subject to the legal restrictions around telehealth or the lack of payment for RPM.

Door #2: Medicaid and CHIP Managed Care Rule. The final rule allows telemedicine to be used to meet network adequacy requirements in Medicaid. Before this rule, Medicaid managed care network adequacy regulation relied heavily on attestations and certifications from states. Now, states will have to develop time and distance standards and hold managed care plans accountable. Given how difficult it can be to find medical practitioners willing to accept Medicaid, telemedicine will be important to ensuring compliance with network adequacy.

Door #3: Medicare and CHIP Access and Re-authorization Act (MACRA) proposed rule. CMS moves physicians, nurses and other practitioners into value-based care by measuring care in four categories– quality, cost (new resource use), clinical practice improvement activities, and advancing care information (new meaningful use). The alternative is moving into an “advanced alternative payment model.” Telehealth figures prominently in assisting practitioners fulfill clinical practice improvement activities.  It is mentioned explicitly as a way to expand practice access and manage patients who receive the drug warfarin. The tools can also apply in meeting practice improvement activities in the population management, patient engagement and care coordination categories. Also, telehealth services are categorized as “patient facing.”

The possibilities for more adoption in Medicare and Medicaid through these avenues is exciting.  However, billing for telehealth and RPM services in Medicare and Medicaid remains difficult.  We still need legislation to update the statute governing the these programs, but CMS’s efforts using existing authority are a step in the right direction.

February 3, 2016 | Krista Drobac, Executive Director of the Alliance for Connected Care

Today represents the first real chance we have had to change Medicare payment policy for telehealth and remote patient monitoring. While the commercial market adopts these tools at a rapid rate, there is virtually no access for seniors in Medicare. This issue got a powerful boost this morning with the introduction of the CONNECT for Health Act in both the U.S. Senate and the U.S. House of Representatives.

Six bipartisan U.S. Senators, including three Committee chairman, and four U.S. Representatives on committees of jurisdiction, came together to introduce a bill that has been endorsed by more than 50 groups, including AARP, the American Medical Association, America’s Health Insurance Plans, the American Heart Association and more.

The CONNECT for Health Act, which is led in the Senate by Senators Brian Schatz (D-HI) and Roger Wicker (R-MS), and in the House by Representatives Diane Black (R-TN) and Peter Welch (D-VT), is a measured approach that lifts Medicare’s outdated restrictions on the use of telehealth, provides resources for remote patient monitoring technology for patients with chronic conditions, ensures new payment models will include these tools, makes these technologies part of Medicare Advantage, and addresses specific challenges related to stroke and dialysis.

Telehealth and remote monitoring are important for achieving the goals of value-based care, providing more access to primary care and behavioral health, improving chronic care management and advancing patient engagement. Patients with commercial coverage have access to these tools through their employers, health plans or health system. The evidence from their usage proves that telehealth and remote monitoring can move our health care system toward better care at lower costs.

According to an independent analysis from Avalere Health, the CONNECT for Health Act will decrease federal spending by $1.8 billion over the next ten-year period. In addition, the study estimates an immediate impact improving patient access with nearly 8.2 million Medicare beneficiaries receiving telemedicine and remote patient monitoring services through a demonstration waiver program by 2017.

It is long overdue for Congress to modernize care and access for all Medicare beneficiaries.