COVID-19 Waivers Improved Medicare Advantage Telehealth Access

August 06, 2020 - Medicare Advantage plans and other stakeholders reported that CMS waivers successfully enabled Medicare and Medicare Advantage telehealth access during the coronavirus pandemic, but several barriers remain, according to a recent study.

ATI Advisory conducted the study on behalf of Better Medicare Alliance’s research arm, Center for Innovation in Medicare Advantage.

The study used data from the 2017 Medicare Current Beneficiary Survey to determine demographic information and interviewed Medicare Advantage and telehealth stakeholders. The interviews included six Medicare Advantage health plans and several providers, vendors, and policy experts.

“The virus has challenged healthcare payers and providers to address new and urgent demands, creating misalignment in supply, demand, and expertise across provider types, facility types, and state lines,” the study acknowledged.

“It has also created the need for new and innovative approaches to serving individuals in their homes, particularly for seniors who have been considered at greatest risk,” it added.

After analyzing the 2017 data, the researchers found that internet access was largely geared toward younger Medicare beneficiaries with medium and high incomes, in more urban areas.  Beneficiaries on Traditional Medicare were more likely to use the internet than Medicare Advantage beneficiaries, across all of the demographics analyzed.

CMS provided Medicare and Medicare Advantage plans multiple flexibilities around telehealth, including extending coverage to Medicare telehealth visits, virtual check-ins, and e-visits and eventually to audio-only services as well.

In the structured interviews with stakeholders, researchers discovered two major themes surrounding implementation and beneficiary experience.

Notably, plans that shared risk-bearing payment models helped plans and providers quickly adjust to the pandemic. These models allowed Medicare Advantage plans to employ telehealth services and expand on existing platforms in a short amount of time.

Also, fee-for-service reimbursement policies were a stumbling block for stakeholders as they navigated telehealth implementation and expansion, for Traditional Medicare and Medicare Advantage beneficiaries alike.

Other factors that accelerated virtual care uptake and expansion included permitting home-based telehealth, eliminating the necessity for providers to have a prior relationship, and expanding the guidelines for provider and service reimbursement eligibility.

As a result of high uptake, seniors who used telehealth during the height of the coronavirus pandemic had a very favorable opinion of it. Over three-quarters said that they would use telehealth again, and 91 percent reported that they had a positive experience using telehealth.

However, there were additional factors that stood in the way, such as Medicare and Medicaid alignment for dually eligible populations, beneficiary access to telehealth technology and internet, and More strict policies that remained in place, such as plan benefit filing.

Better Medicare Alliance offered five recommendations, two to increase access and three to improve processes and payment for telehealth.

First, the alliance suggested increasing access to telehealth by rectifying portions of the Social Security Act that restrict telehealth usage based on whether the beneficiary’s home is the originating site, whether the patient lives in a rural or urban area, and the provider type and history with the beneficiary.

Second, CMS should broaden the definition of acceptable telehealth modalities to audio-only and asynchronous platforms and adjust the Medicare Advantage bid process to continue innovating telehealth technologies, even during the contract year.

By pivoting away from fee-for-service payment models for telehealth, CMS could streamline and further incentivize telehealth use, the alliance suggested.

Finally, CMS should update risk adjustment with virtual care in mind, by ensuring  Medicare Advantage plans and providers receive reimbursement equal to the task of providing telehealth care.

“The expanded policies during the COVID-19 public health emergency, including audio as a reimbursable telehealth modality, have resulted in similar rates of access regardless of age demographic, race/ethnicity, income level, and urbanicity,” the study concluded.

“In concert with legislative action, CMS should continue the new momentum that has fostered innovation and access to care.”