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Mason faculty outlines what is required to develop a coherent telehealth strategy that increases access, addresses disparities, and improves care.
Telehealth as a channel for delivering care has boomed in the past few years in response to the growing need for more flexible opioid treatment options and limitations to in-person care during the COVID-19 pandemic. But for states, payers, and providers to deliver on the long-term promise of telehealth, areas such as funding, infrastructure, policy, access points, and coverage must also evolve.
A recent issue brief, Steps Toward a Coherent Telehealth Policy, by Alison Cuellar, PhD, Professor in the Department of Health Administration and Policy at George Mason University, provides a comprehensive overview of the opportunities to innovate telehealth policy to drive adoption, expand coverage, and improve care. The brief, co-written with Anton Arbatov, adjunct faculty and vice president at SOC Telehealth, and Constance Owens, PhD student in the Health Services Research program, explores the complexities of licensure, payment policy, and policies for safety net providers.
While many of us equate innovation and telehealth with virtual visits with a doctor, this form of telehealth makes up less than 40% of revenues. Cuellar explains that there are actually three major segments of the telehealth sector: virtual visits (whether between patient and provider or two providers), remote monitoring services, and store-and- forward services for sharing digital images and video between providers. Cuellar examines the three models as well as their unique policy, delivery, and cost-structuring challenges—helping readers navigate the complexities and considerations.
“The true innovation related to telehealth is not just the technology – it is the behind the scenes work to foster wide-spread and equitable adoption. This will require creative and flexible ways of thinking about who can provide telehealth services, what kind of services will be covered, where the patient can receive care, and who will pay for it. There is too much at stake not to innovate,” says Cuellar.
Cuellar’s Policy Brief addresses some of the unknowns and obstacles associated with telehealth- such as whether increased convenience will lead to more appointments and higher costs, but with marginal benefits– and the challenges associated with conducting a physical exam remotely. The brief focuses on policy issues such as reimbursement policies and how they differ across payers and activities. For example, she illustrates differences in Medicare coverage depending on the “originating site of care”, the nature of the service provided, and how the service is delivered. Cuellar also authored an opinion piece in The Hill on March 20, which further explored a “post-COVID reimagining of telehealth in Medicare.”
An expert in health policy and health systems, Cuellar points to amazing innovations whereby dentists deliver care, children receive care at school, and psychiatrists see patients in emergency rooms – all remotely. States are also expanding the list of eligible providers who can be paid for their remote care to include dentists, speech or physical therapists, for example. Allowing more providers to deliver care across state lines though licensure changes is also key to expanding telehealth. The Brief underscores the need for further innovation in these areas to reach the full potential for addressing disparities and reaching underserved populations.
The Brief outlines many opportunities for innovation. For example, Cuellar sees behavioral health and counseling services as areas where telehealth can help address growing demand and provider shortages. She encourages payers to consider the types of care that are possible via remote video, how to expand access and improve care, and the types of care that could originate in a patient’s home.
In some instances, regulation has not been able to keep pace with changes in state laws creating a dynamic environment. Cuellar foresees that definitions of telehealth modalities, cross-state licensure, patient consent, and online prescribing as “active areas of policy development.”
While telehealth innovation was originally driven by the opioid crisis and COVID-19, all three segments of telehealth hold great potential for improving access and quality of care. Advancements in the areas of federal and state investment, coverage, licensure, and payment policy can further promote innovative care and reduce disparities.
For questions about telehealth policy or other matters related the health policy, contact Alison Cuellar at aevanscu@gmu.edu.