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Can Telehealth Fill Health Insurer’s Provider Network Gaps?

Although providers and health insurers alike acknowledge the benefits of telehealth, insurers still aren't using it to fill provider network gaps.

- Telehealth services may not be a cure-all for health insurance provider network growth, but it does hold many benefits to expand patient access to healthcare, recent research from the Robert Wood Johnson Foundation says.

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In a report published this month, researchers from RWJF examined the relationship between telehealth services and health insurance coverage, looking to see if the technology could help fill gaps in insurance networks.

“As the trend toward narrower networks continues, policy-makers, consumers, and provider stakeholders have encouraged insurance regulators to place the adequacy of provider networks under closer scrutiny,” the researchers wrote. “In response, some state and federal regulators have proposed more robust, quantitative network adequacy standards to ensure that consumers have reasonable access to services under their health plans.”

The researchers found that health insurers recognize significant benefits to implementing telehealth, particularly in offering healthcare to those in rural and underserved regions and in supplementing healthcare. As provider networks become narrower, telehealth has the potential to help insurers reach more patients.

“Given this evolution in the regulatory approach, insurers may have incentives to use alternative delivery methods such as telemedicine to meet network adequacy standards, particularly in regions where insurers face provider shortages,” the researchers reported.

Some industry leaders advocate for such use of telehealth, including the National Association of Insurance Commissioners and its recent model law for boosting provider networks. This law acknowledged the potential for telehealth to improve provider network adequacy.

“The model law does not establish quantitative network adequacy metrics, but it does include the use of telemedicine under its criteria as a health care delivery option that insurers may use to meet a state’s network adequacy standard,” the research team said.

It is not just health insurers who tout the benefits of telehealth. Large hospitals and health systems are leading the charge in spreading telehealth, using it to deliver care to patients in disparate locations.

“From postoperative monitoring of patients at home to connecting specialists with emergency room doctors in rural areas, hospitals are investing in and using telemedicine platforms,” the researchers noted.

Hospitals also use the technology to support risk-based financial models by supplementing healthcare, preventing further health maladies, and reducing hospital readmissions.

“Hospitals and health systems are using telemedicine not only to increase access to their services but also to respond to changing payment models that encourage them to emphasize the management of high-risk conditions and chronic diseases such as diabetes, as well as to lower readmissions,” the researchers wrote.

That all said, there are significant barriers blocking telehealth from completely filling provider network gaps. For some healthcare specialties, such as emergency department doctors, telehealth reportedly has limited effectiveness.

There are other logistical barriers limiting the use of telehealth to fill provider network gaps.

“Some respondents also indicated that, even for some specialty services that are more amenable to deliver care through telemedicine (such as behavioral health, dermatology, and radiology), the needed workforce and technical infrastructure just do not exist,” the report stated.

Likewise, telehealth may call for more robust physician support if a patient needs in-person assistance in addition to the telehealth providers’ consultation.

As a result, insurer uptake of telehealth has been notably slow. According to the RWJF researchers, insurer compensation for telehealth is not ubiquitous across the nation due to a lack of standardized regulations. While some states may reimburse telehealth visits equally to the same in-person service, others may not recognize telehealth at all because there are no federal guidelines.

Going forward, providers may react to new regulatory policies about telehealth delivery. However, as of present, they do not increase their uptake in telehealth as a means to alleviate provider network gaps. Although they acknowledge the benefits telehealth may have, federal regulations may keep them from fully adopting the practice into their services provided.

“Insurers generally do not appear to be using telemedicine to fill gaps in plan networks or to meet state network adequacy standards,” the researchers concluded.

“There is uncertainty about how state and federal regulators would assess the use of telemedicine, particularly where telemedicine encounters could be perceived as replacing, rather than supplementing, face-to-face access to a physician. In addition, the lack of payer and provider investment in the necessary technology, as well as concerns from organized medicine, has led to a lack of infrastructure and integration into medical practice.”

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