Nearly all provider and health plan organizations are highlighting telehealth as a first-line defense for patients who think they may be infected with COVID-19 to keep them away from urgent care, emergency departments, and hospitals where further spread is inevitable. Aetna, AmeriHealth NJ, Humana, Oscar, Optima, and the BCBS plans of Arizona, Massachusetts, Nebraska, and New Jersey have all temporarily eliminated cost-sharing on virtual visits to attract members to get urgent and acute care without risking exposure. Many other plans and the BCBS Association are expanding their telehealth service capacity and staffing up their nurse/provider hotlines.

Strategic responses to COVID-19 by health plans

As of 6 p.m. ET on March 23, 2020

MVP HEALTH CARE AND CDPHP

• Strategy: Capital District’s Physicians’ Health Plans (CDPHP) and MVP Health Care in New York partnered to allow their providers to offer both diagnostic and prescription services over the phone for coronavirus.
• Result: The plans quickly stood up a virtual ED triage system. Members can connect with a live, emergency-trained United Concierge Medicine provider who can assess their condition and determine whether they may have contracted COVID-19. The provider can then arrange for a test or tell the member to go to an in-person facility.

OSCAR HEALTH PLAN

• Strategy: Oscar created the first tool to locate testing centers for COVID-19. The tool is linked to an online virtual assessment and Oscar’s virtual visit service, Doctor on Call.
• Result: Oscar offers different modalities of care to members through its technology tools. The virtual assessment and test locator tool helps members find services on their own. The direct link to Doctor on Call allows members to quickly speak to an expert instead of traveling to a health care facility.

AETNA

• Strategy: Aetna eliminated its copay for all virtual visits until June 4, 2020. Aetna is also covering virtual evaluation and monitoring visits for all members, even though they are normally just for Medicare Advantage (MA) members.
• Result: By eliminating the cost of virtual visits, members with complex conditions can receive follow-up care without going to the provider’s office. This allows potentially high-risk members to maintain self-isolation while receiving the care they need.

Consider how to increase awareness of virtual care options andreduce the burden on members to access these services—especially the burdens of cost.

Determine how to encourage provider organizations to usetelehealth to protect physicians and other staff members frompotential COVID-19 exposure.

The use of telehealth is increasing. Think about how your plancan analyze the effectiveness, member satisfaction, and ROI ofnewer telehealth use to deploy initiatives after COVID-19.

Virtual visits, under the broad spectrum of telehealth, are defined as “the use of electronic information and telecommunications technologies to support longdistance clinical care, patient and professional health-related education, public health and health administration.” Virtual visit providers remotely diagnose and treat patients through real-time audiovisual information exchange.

With 96% of the largest U.S. employers offering telehealth insurance coverage in 2019, telehealth is quickly growing from a health care buzzword to an expected offering. According to FAIR Health, private insurance claims for telehealth have increased 53% year-over-year compared to the 7% and 6% growth of alternate sites of care like retail clinics and ambulatory surgery centers. However, virtual visits accounted for only about 0.11% of all medical claims in 2017.

• $4.3B estimated annual U.S. health care savings from all modes of telehealth
• 48 million hours are freed up for PCP workforce if virtual visits used 
• 1% of Medicare beneficiaries used telehealth in 2019
• 13% of surveyed Americans repeat a virtual visit for a second time

Health plans offer virtual visits to improve member access, reduce costs via an alternative site of care, and meet the needs of purchasers. Recently, some plans have started to leverage virtual visits for "tele-triage" methods to help providers and hospitals manage capacity, meet access and supply deficiencies through behavioral health telehealth providers, and act as a referral mechanism to ensure members visit in-network providers that are low-cost but high-quality.

Barriers that have limited the rapid expansion of virtual visits for payers include complex state regulations, a lack of member education, provider enablement issues, and difficulty in calculating ROI based on the data available.

In March of 2020, CMS announced that it is expanding Medicare reimbursement for a wider range of telehealth services. The expanded scope of reimbursed services is intended to limit patient travel and preserve provider capacity in response to COVID-19, and will continue throughout the federal coronavirus public health emergency.

Some of these changes include: patients can access telehealth visits from home, patients and providers can connect through their smartphones, patients don’t need existing relationships with providers to get a reimbursed telehealth visit, and providers can waive or reduce cost-sharing requirements. All of these changes show a change in Medicare’s traditionally restrictive approach to virtual visit technology.

Increase in virtual visits due to COVID-19, as of March 17, 2020 

• 50% increase in virtual visits for Teladoc and Doctor on Demand
• 20-fold increase in virtual visits at Jefferson Health in 6 days
• 10x increase in number of practitioners delivering remote consults at the University of Pennsylvania

Following suit, health plans in the commercial market are also responding to the COVID-19 pandemic by expanding coverage and marketing for virtual visits. Plans are leveraging this technology to improve member access, reduce costs via an alternative site of care, and "tele-triage" patients so providers and hospitals maintain capacity and meet access and supply deficiencies through primary care and behavioral health telehealth providers. Ultimately, plans hope virtual visits will act as a referral mechanism to ensure members visit in-network providers that are most appropriate for their symptoms during this pandemic.

Amid the COVID-19 outbreak, CMS announced on March 17, 2020 that they would waive cost-sharing for COVID-19 treatments and services delivered via telehealth as well as expand access to certain telehealth services for Medicare Advantage and Part D beneficiaries. The House’s coronavirus legislation includes around $500 million to allow Medicare providers to offer telehealth services so that seniors at greater risk from the virus can receive care remotely.

CMS is also giving providers more flexibility to deliver virtual visits from their own mobile devices and receive reimbursement. Respiratory problems—an early symptom of COVID-19—are commonly evaluated with virtual visits. Virtual visits enable providers to easily obtain detailed travel and exposure histories, automated screening algorithms can be built into the intake process, and local epidemiologic information can be used to standardize screening and practice patterns across providers.