Insurers generally have avoided using telemedicine providers within their provider networks, despite the widespread physician shortages in some areas, according to the new study “Can Telemedicine Help Address Concerns with Network Adequacy?”
The study prepared by researchers at Georgetown University http://chir.georgetown.edu with funding from the Robert Wood Johnson Foundation (RWJF) www.rwjf.org shows that insurers could meet new provider network size requirements by covering telemedicine especially for consumers in rural or underserved urban areas.
Through interviews with officials in six states including Arkansas, Colorado, Illinois, Maine, Texas, and the State of Washington, researchers identified the pros and cons for insurers to expand coverage via telemedicine services.
The interviewees said that telemedicine could expand access to primary care as well as specialists. These specialists can include psychiatrists, cardiologists, and endocrinologists, but insurers are more likely to use it as a supplement to and not as a replacement for in-person services.
Insurers are reluctant to use telemedicine to meet state network requirements in part because they do not know how it will be viewed by state regulators. The authors say that insurers also often face opposition from local clinicians who think telemedicine could replace them or be used as leverage against them in negotiations over fees.
“The expansion of telemedicine is inevitable, but the challenge is to identify approaches that will either improve quality or reduce costs,” said Kathy Hempstead, who directs coverage work at RWJF. “With the trend toward stricter definitions of network adequacy in states, there may be ways that telemedicine can help carriers demonstrate that they are providing adequate access to their members.”
Go to www.urban.org/policy-centers/health-policy-center then click on publications to view the study “Can Telemedicine Help Address Concerns with Network Adequacy? Opportunities and Challenges in Six States” published April 2016.