Why won’t health plans pay for telehealth visits?

April 15, 2019 / By L. Gordon Moore, MD

How long will it take until health plans catch up with the evidence? Non face-to-face visits can:

• be done well
• provide excellent care
• improve outcomes
• improve satisfaction
• reduce healthcare costs

The biggest impediment to delivering care this way is “Insurance won’t pay for that.” It makes me want to bang my head on the wall.

Dr. Travis Bias (a colleague) forwarded me a newspaper article describing the benefit of telehealth visits. The article describes how some specialists can provide stroke services over wide geographic areas, which can reduce the time to effective diagnosis and treatment. This should lead to improved outcomes, saved lives and reduced unnecessary costs.

Eight years ago, a group of researchers at UC Davis published a paper describing the feasibility of using simple web cameras and secure file transfer to delivery psychiatric services to underserved populations in California. They found that it is feasible, accepted well by patients and doctors, and confirmed in a follow up study to be quite cost effective. I had the chance to hear the principle investigator describe the findings that primary care providers (PCPs) and patients could have in an asynchronous consultation recorded while the patient was in the PCP office. This pretty much eliminated the problem of attrition, when people leave the PCP office with a referral to psychiatry that they must then negotiate.

Twenty six years ago, John Wasson et al reported in JAMA that telephone calls provided very good follow up as a substitute for routine clinical visits. The results were improved patient satisfaction, improved health outcomes and lower healthcare costs.

These are just some of the points of evidence supporting non visit-based care. There are reasonable concerns about just turning on new payment streams, but the evidence for supporting these streams is good and with thoughtful crafting of policy we can mitigate the concerns. It’s long past time to align payment policy with advances in care delivery.

L. Gordon Moore, MD, is Senior Medical Director, Clinical Strategy and Value-based Care for 3M Health Information Systems.