New policy recommendations that provide a roadmap for the post-pandemic use of telehealth technologies in Massachusetts were presented today at a virtual Massachusetts Health Policy Forum (MHPF) at The Heller School of Social Policy and Management, Brandeis University.
According to the analysis derived from literature review and qualitative interviews of stakeholders throughout Massachusetts, telehealth use during the COVID-19 pandemic increased in Massachusetts more than 3,000 percent from February to March, 2020, drastically changing how patients currently receive health care services.
According to Dr. Mark Keroack, CEO of Baystate Health, telehealth technologies have proven their worth during the COVID-19 pandemic. He predicts telehealth will become part of the provider’s standard toolkit for care delivery going forward. “At Baystate Health, telehealth technologies have enhanced patient safety during the pandemic and improved both convenience and access to care. Beyond these direct to patient applications, telehealth has enabled providers across our wide service area to access specialty expertise to improve patient care. Innovative uses of these technologies are evolving daily in all of our practices,” Dr. Keroack said.
The MHPF report found that while use of telehealth during COVID-19 greatly expanded access to care, it is not a panacea. Many patients did not have access to the internet and video devices, which the study concluded is something that needs to be addressed to avoid future disparities in care.
“Patient health literacy and access to technology remain barriers to widespread adoption of more advanced telehealth applications. Many of the state and federal policies around insurance reimbursement and telehealth delivery are due to expire at the end of the public health emergency,” according to the report’s co-author and researcher Ben Kragen, a PhD and MBA student at The Heller School.
Prior to COVID-19, Massachusetts did not mandate coverage of telehealth, which contributed to low telehealth use in Massachusetts (Augenstein et al., 2020). Telehealth use spiked in the Commonwealth in response to policy shifts on both a federal and state level, with some providers having little to no telehealth visits prior to the pandemic, to having telehealth visits comprise the majority of their outpatient visits in a matter of weeks.
At the federal level, Medicare declared that care delivered over telehealth platforms be reimbursed at the same level as in-person visits. Center for Medicare & Medicaid Services (CMS) temporarily lifted requirement that providers be licensed in the state that they provide services. The Office of Civil Rights temporarily suspended the requirement that telehealth technology be HIPAA compliant. Early in the pandemic MassHealth, the Massachusetts Medicaid organization, declared that all telehealth services be reimbursed at the level of in-person services for the duration of the public health emergency, while lifting originating site requirements which allowed patients to receive care in their homes. In March, Governor Charlie Baker released an executive order that extended these changes to all payers.
Blue Cross and Blue Shield of Massachusetts noted that a majority of early 2020 telehealth claims were for behavioral health visits from mid-March to the end of April (Becker, 2020). Overall outpatient mental health and substance use disorder visits increased by 9% during the COVID-19 surge compared to pre-pandemic 2020 (Yang et al., 2020). By contrast, outpatient non-behavioral health appointments decreased by 38% (Yang et al., 2020).
“Blue Cross and Blue Shield of Massachusetts is actively engaged in the promotion of mental health and addiction care through teletherapy,” according to Senior Medical Director, Dr. Kenneth Duckworth. “Our decision to add telephone sessions as a covered service during this difficult period helps provide our members with greater access to needed care.”
Regarding future use of telehealth technology, the report found significant alignment among payers, providers, and patient advocacy organizations, which informed ten recommended policy changes included in today’s report:
- Commission and review evidence-based studies on the efficacy of telehealth.
- Foster and continue efforts to move towards value-based payment models.
- Make reimbursement for audio-only telehealth visits a permanent option in addition to video where appropriate based on study of efficacy.
- Allocate resources to overcome disparities in access to telehealth technologies.
- Enter into the interstate licensing compact.
- End originating site requirements.
- Educate providers about payable codes for covered telehealth services.
- Educate providers about reimbursement codes for pharmacists and nurses.
- Develop HIPAA compliant software services that are compatible with widely used technologies.
- Develop applications that facilitate group engagement in care.
More information about the MHPF report: Telehealth in a Post-Pandemic World.