Value-Based Care News

22% of Those With Rural Healthcare Lack Telehealth Coverage

Telehealth offers solutions for rural healthcare, but payers are inconsistent about covering telehealth services.

Payers inconsistent in coverage for telehealth services

Source: Thinkstock

By Kelsey Waddill

As 25 percent of rural Americans continue to struggle with access to care and about an equal amount turn to telehealth for solutions, experts push payers for better telehealth coverage to improve rural healthcare, according to a new report.

According to the report, which was conducted by NPR, Harvard’s T.H. Chan School of Public Health, and the Robert Wood Johnson Foundation, most rural Americans have health insurance coverage, but access to care remains difficult. 

Affordability was the reason top reason that those experiencing rural did not receive care when they needed it in the past few years, the report finds. But 19 percent of respondents also said they could not find a provider who would accept their health insurance.

“Even with major improvements in health insurance coverage over the last decade, it is concerning that one in four rural Americans are struggling to get the health care they need,” Robert J. Blendon, co-director of the survey and the Richard L. Menschel professor of health policy and political analysis at Harvard T.H. Chan School of Public Health said in a press release.

Patients in rural communities are turning to telehealth for solutions. A quarter of rural adults have used telehealth in the past few years (e.g., diagnosis or treatments from health professionals via phone, email, messaging, chat, mobile app, live video, etcetera) and report high satisfaction and convenience, the report shows.

Telehealth is a potential solution for rural healthcare challenges due to its convenience. For 69 percent of rural telehealth patients, they chose the platform because it was “the most convenient way to receive a diagnosis and treatment.” Others turned to telehealth when they were unable to see a provider in person or it was too challenging to travel to a provider or hospital.

However, telehealth still faces its own challenges in the rural setting. Public and private payers are inconsistent in how they charge for telehealth services, the report shows. Furthermore, one in five rural families has trouble accessing high-speed internet, which is typically a necessity for telehealth platforms.

Some experts are calling on payers to improve coverage for rural telehealth.

According to the report, payers charged about four in ten video, email, text, or app telehealth users for their most recent telehealth activity. Of these, 22 percent say that their health insurance covered no part of the bill. For 61 percent, insurance would cover part of their telehealth expense for these services. Only 14 percent received full coverage.

NPR reports that according to Mei Kwong, JD, executive director of the Center for Connected Health Policy in Sacramento, the lack of full coverage for rural telehealth patients is “unfortunate...especially for underserved communities where there is a shortage of specialists.”

Kwong is confident in telehealth’s ability to provide healthcare solutions for rural America. However, she claims that health payers “lag way behind the technology.” Payers support policies that are ten to fifteen years behind telehealth’s advancements, she explains. Furthermore, members are not guaranteed full coverage from their private payers and even Medicare and Medicaid when it comes to telehealth services.

But some payers are bolstering their telehealth coverage, especially to support rural healthcare. Leading the charge is Medicare.

CMS finalized a policy in April that would extend telehealth benefits to Medicare Advantage members.

“With these new telehealth benefits, Medicare Advantage enrollees will be able to access the latest technology and have greater access to telehealth. By providing greater flexibility to Medicare Advantage plans, beneficiaries can receive more benefits, at lower costs and better quality,” said CMS Administrator Seema Verma.

The finalized policy enables at-home care and broadens the scope of telehealth benefits outside of rural communities.

In May, Verma also addressed the National Rural Health Association Annual Conference. In her speech, she cited new Medicare telehealth policy advancements such as providing coverage for home dialysis, mobile stroke unit technologies, in-home monitoring, and remote information sharing. CMS also reimburses Rural Health Clinics and Federally Qualified Health Centers for virtual check-ins.

Such coverage is proving critical for rural communities with cost and transportation barriers, she emphasized by citing successes in West Virginia, where West Virginia University Medicine used telemedicine to help cancer and Alzheimer patients get quality care closer to home.

Various changes will be required in the healthcare industry for telehealth to bring health benefits to rural America. And as telehealth grows, payers will continue to hear the call for greater coverage consistency and more benefit options for rural communities’ telehealth services.