Telemedicine in America is undergoing not just an evolution, but a revolution, one that has been accelerated by the COVID-19 pandemic.
The massive shift to telemedicine is not simply anecdotal — health insurance data proves that the industry is seeing a ground-breaking transformation. Telemedicine-related claims increased 8,336% in April 2020, compared to a year prior, and accounted for 13% of all medical claims in April 2020, compared to just 0.15% in April 2019, according to FAIR Health’s Monthly Telehealth Regional Tracker.
At the center of the telemedicine revolution are health plans and agents, now serving a clientele whose expectations are evolving to a new normal and are not likely to return to pre-pandemic standards of care access and reimbursement. Importantly, telemedicine use has greatly expanded beyond the services that have commonly been administered via remote care in the past, such as behavioral health benefits. According to FAIR Health, mental health conditions remained the most frequent telemedicine claims in March and April 2020, compared to the year prior. However, the rest of the conditions that round out the top five telemedicine claims greatly evolved. For example, acute respiratory issues comprised 16.84% of telemedicine claims in April 2019 but dropped to just 3.08% in April 2020. Instead, telemedicine claims for joint and soft tissue diseases and hypertension became more prevalent, at 5.83% and 3.71%, respectively.
It comes as no surprise, then, that “ocular telemedicine” — or telemedicine for eye care and vision health — has entered the insurance and benefits conversation. In fact, health plan executives say that members’ ability to use technology to meet with eye care professionals would have the highest impact on their receptivity to purchasing vision insurance, according to Versant Health’s inaugural Vision Wellness Study.
Health insurance agents and brokers who understand the opportunities that ocular telemedicine affords, as well as how changes are being made for the better, are in position to demonstrate the value of vision benefits in a world where their clients are shifting their understanding of insurance and re-evaluating even the smallest of costs.
Modern ocular telemedicine is more than live video chats.
There is a general assumption that ocular telemedicine accessed through vision benefits is limited to traditional, synchronous video conversations with eye care professionals. However, in reality, ocular telemedicine comprises a wide range of care capabilities and advanced technologies — from participating in vision screenings performed via mobile devices, to retinal imaging for high-risk patients at point-of-service locations, to emerging artificial intelligence applications for monitoring eye health.
Most impactfully, vision care plans are have moved away from approving only synchronous methods of communication and moved toward approving asynchronous communication and patient home monitoring in telemedicine services. Asynchronous ocular telemedicine refers to communication between patients and eye care professionals that does not happen in real time, typically denoting virtually transmission of test results for a later assessment. Home monitoring refers to eye care professionals’ continued assessment of patients’ health status, typically meaning at-home updates and images digitally provided by patients at regular intervals.
Both additions mean more patients get access to — and are insured for — needed eye care, no matter the environment nor their stage of life. Given the proven links between eye health and overall health, vision benefits with these expanded ocular telemedicine approvals allow clients to save money through early detection of vision and wellness issues.
Remote eye care is intrinsically married to in-person care.
According to the “Telemedicine Impact on Health Care Cost and Quality” report by the American Telemedicine Association, outcomes using telemedicine technologies in coordination with “usual care” were similar or better than outcomes with “usual care” alone.
This concept extends to ocular telemedicine, which does not entirely replace in-office visits with eye care professionals. While ocular telemedicine is undoubtedly required in some cases — the COVID-19 pandemic being the one of them — there are instances where in-person eye care is required for sufficient diagnoses and testing, and telemedicine may not be the first point of contact.
Rather, ocular telemedicine should be positioned as a benefits enhancement that strengthens the relationship between eye care professionals and their patients — providing trust and reassurance on an ongoing basis, particularly for those patients who are likely to present with frequent eye issues, such as diabetics.
Policy changes are making ocular telemedicine access wider and simpler.
National, state and private insurers and professional insurance associations have faced mounting pressures to improve telemedicine reimbursement policies, with the COVID-19 pandemic speeding up those changes. In March 2020, the Centers for Medicare and Medicaid Services (CMS) broadened access to Medicare telemedicine pandemic to allow a wider range of services to be covered — and CMS leadership indicates that this change could be here to stay. To add, there are reports that new legislation regarding tracking, maintaining and improving our ability to provide care through telehealth are receiving bipartisan support.
For ocular telemedicine, specifically, there are still state-by-state limitations on the type of eye care that can be reimbursed by insurers, but more guidelines are being put forth the ensure that most health plans are operating by the same set of standards that improve access to eye care. The National Association of Vision Care Plans recently released a new telemedicine policy statement that helps “serve as a guide for working with managed vision care plans who offer ocular telemedicine as a covered service.”
While ocular telemedicine is still evolving, these policy changes highlight the confidence that health plans have in it for care delivery to their members — and they are frequently committing to re-examining their methods, as needs and opportunities for better options arise. Thus, the value of accessing ocular telemedicine through vision benefits, even as the world is changing, is abundantly clear.
Dr. Mark Ruchman is the chief medical officer at Versant Health, a managed vision care company.