It may be hard these days to pull your attention away from Washington, but it’s necessary.
Whatever the people in Washington do, or don’t do, about the Affordable Care Act, your clients still need protection against catastrophic health problems that could cost them the ability to live on their own.
For some, improvements in telehealth services, or efforts to provide health care through telecommunications and electronic information networks, could make a big difference. Improved telehealth systems could slash the cost of keeping people with severe health problems in their homes. Some might be able to continue to work, either inside or outside the home.
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Telehealth providers are pushing state and federal policymakers to make health plans pay as much for telehealth services as for otherwise comparable in-person services.
The plans are thinking about adding telehealth benefits, and ways to tighten telehealth benefits provisions, to maximize the amount of care value per dollar spent.
Florida legislators have responded by setting up a state advisory council to come up with telehealth support recommendations.
The Florida Agency for Health Care Administration recently worked with the Florida Department of Health and the Florida Office of Insurance Regulation to prepare a major telehealth report, to give the council information it can use when developing the recommendations.
Related: Could insurers get Grandma Wi-Fi?
Here’s a look at some AHCA findings that might be of interest to advisors who help clients protect themselves against health, disability and long-term care risk.
Florida health coverage providers were great about filling out their state telehealth questionnaires. (Image: iStock)
1. Some players are a lot more engaged than others.
The AHCA telehealth team based part of its report on results from surveys of 54 insurers, 11,900 health care-related facilities, and tens of thousands of licensed health care professionals.
All 54 health plans completed questionnaires.
About 49 percent of the health care facilities responded, with response rates ranging from 40 percent for clinical laboratories, up to 87 percent for pediatric extended care centers.
The report team described the licensed professionals’ response rate as “relatively limited.”
About 32 percent of the medical doctors responded, but only 3 percent of the occupational therapists and 5 percent of the hearing aid specialists filled out questionnaires.
Related: A futurist’s view on healthcare
In Florida, many hospitals can videoconference with patients. (Photo: Thinkstock)
2. Hospitals are the biggest telehealth users.
Long-term care planners might think of telehealth mainly as a way to keep people with serious chronic health problems out of nursing homes, but acute health providers see it as a tool for improving the quality of the care they deliver.
Hospitals, in particular, want to use telehealth tech to improve care, and they operate big buildings full of professionals who can help them get telehealth tech to work.
About 46 percent of the participating hospitals said they videoconference with patients, and 18 percent said they use remote patient monitoring systems.
The moral: Technology should help level the playing field for the little player. But in reality, the great big hospital is the player with the staff that knows how to get Skype to work.
Long-term care providers are not yet making heavy use of most telehealth services. (Photo: iStock)
3. Long-term care providers are starting to scratch one surface.
Florida home health agencies and hospitals are starting to use remote patient monitoring systems to look after patients who need short-term post-acute care or long-term care, and that’s about all most post-acute care providers do with telehealth services.
The long-term care providers were good about getting their questionnaires in. The response rate was 43 percent for the state’s assisted living facilities, 44 percent for the home health agencies, and 72 percent for the nursing homes.
Forty-four percent of the home health agencies and 18 percent of the hospitals said they use remote monitoring technology, and 11 percent of the hospitals said they used some kind of telehealth systems to watch patients with cancer or chronic diseases.
But fewer than 10 percent said they use video calls, telephone calls or less common types of telehealth systems to help patients.
Related: 5 ways to increase use of telehealth
Health care professionals tend to use their own cash to pay for telehealth tech. (Photo: Thinkstock)
4. Health care professionals usually have to pay for their own telehealth tech.
About 67 percent of the licensed professionals who said they use telehealth technology had to pay for the technology themselves, one way or another.
The Florida report writers had to turn to a U.K. study to get hard data on the effects of telehealth on health care system efficiency. (Photo: Allison Bell/LHP)
5. Results from some pilot projects outside of Florida sound great.
The Florida report team supplemented their survey results with descriptions of well-known examples of major telehealth efforts.
At one 360-bed nursing home in New York state, for example, an effort to give residents access to physicians through videoconferencing helped 91 residents avoid hospital visits.
In the United Kingdom, a remote patient monitoring program reduced the mortality rate for high-risk patients by 45 percent.
Care providers say use of telehealth services is great for patient convenience. (Photo: Thinkstock)
6. Getting paid for remote monitoring services is still complicated.
Twenty-eight states now require insurers to cover care provided through video calls the same way they would cover comparable care delivered in-person, the telehealth report team found.
Only 17 states’ Medicaid programs cover remote patient monitoring services.
In Florida, traditional Medicaid pays only for live videoconferencing, not for remote patient monitoring. Medicaid managed care plans can decide for themselves whether to cover remote patient monitoring.
Care providers see payers as a major barrier to increased use of telehealth systems. (Photo: iStock)
7. Providers say reimbursement is a telehealth turn-off.
Florida health care providers say government regulation, liability lawsuits and technology costs are the three top barriers to them increasing use of telehealth tech.
But insurance concerns hold three other slots on the telehealth barrier list.
Thirty-seven percent of providers worry about problems with reimbursement and payment guidelines. That ranks fourth on the list of concerns.
Confusion over just what kind of telehealth service will lead to reimbursement ranks eighth on the list, and “lack of knowledge in the health insurance community about viable telehealth solutions.”
The bad news here is that providers may be blaming their own sloth and resistance to change on insurers. The good news is that it’s possible that, if insurers want to get providers to make more use of telehealth tech, they might be able to expand use by adding telehealth reimbursement parity provisions, or telling providers about existing telehealth reimbursement options.
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