If there’s a readily visible upside to the COVID-19 pandemic, it may be that telehealth is not only much more accessible, it’s also supremely topical among policymakers. However, privacy concerns are still a significant source of drag in some respects, a consideration that extends to digital medicine as well in the context of contact tracing used to corral the SARS-CoV-2 virus.
Jennifer Danielson, senior vice president for public policy at Cambia Health Solutions Inc., of Portland, Ore., was speaking on a webinar hosted by the D.C.-based App Association, and said Cambia recognized early on in the pandemic that the needs of non-COVID patients might be difficult to meet. “Our telehealth claims overall are up 4,900%” since the start of the pandemic, Danielson said, indicating that the solution was readily adopted by health care professional (HCP) and patient alike.
Behavioral health visits conducted via telehealth are part of the skyrocketing utilization trend at Cambia, Danielson said, adding that the privacy question for medical records generally has devoured a large amount of bandwidth in Washington as a policy question. The pandemic has amplified those concerns, but Danielson said, “we see this issue of privacy as going hand-in-hand with interoperability” and other issues that need the help of policymakers in Washington.
“It’s not that we can’t do contact tracing” in a manner that is expeditious and reliable, Danielson said, but rather that “we as citizens are not ready to trust government institutions with what they do or might do with that data.” These questions are likely to outlive the current pandemic, but Danielson said state and local governments are grappling with the same dilemmas when privacy and contact tracing intersect. “I don’t see an easy solution coming to the forefront quickly,” she said, adding that the private sector can play a role by demonstrating how good stewardship of patient data can be achieved.
Danielson said these issues will remain highly topical for Cambia for the foreseeable future, adding that Cambia and others in the health care ecosystem would do well “to figure out a solution to this while we figure out how we further capture and enable that access, and position ourselves for future responses as well.”
Expanded Medicare coverage will lapse
Morgan Reed, who serves as both the president of the App Association and the acting executive director of the Connected Health Initiative, said the pandemic has highlighted a point made by stakeholders for decades in some instances, that digital medicine “can radically improve patient outcomes,” and allows HCPs to meet the patient’s needs at home.
Reed said telemedicine has demonstrated a capacity for restoring the more intimate nature of the physician-patient relationship that existed when physicians made home visits. Conversely, there are concerns about both payment and liability for any unintended breaches of privacy, Reed said. He said also that in a recent year, telemedicine had accounted for only $30 million out of a total of $1 trillion in total reimbursement for Medicare and Medicaid, a percentage he said needs to rise substantially.
The pandemic has lent a new urgency to the telemedicine conversation, and Reed said the majority of patients’ needs have nothing to do with COVID-19, but instead are for conditions such as diabetes, maternity care and heart disease. The temporary changes to coverage put in place by the Centers for Medicare and Medicaid Services have allowed physicians to be reimbursed for telehealth, a change that has prompted developers of digital health applications to take note, he said.
“Unfortunately, this progress is temporary and lapses at the end of the public health emergency,” Reed noted, adding that a recent survey indicated that 40% of respondents had used telehealth since the beginning of the public health emergency. Of this group, 90% said the virtual visit had met their needs, a clear signal that telemedicine has won over a significant chunk of the patient population.
Another survey indicated that 80% of likely voters support the continuation of telehealth coverage after the pandemic has ended, and Reed said that more than four in five Americans have a smartphone, thus answering any questions about whether most patients can digitally engage. That ratio of possession of smart devices holds for nearly all demographics, although Reed noted that the build up of broadband is deficient in some geographic areas.
Rep. Bill Johnson (R-Ohio), who chairs the Congressional Telehealth Caucus, also participated in the webcast, and noted that he is one of the co-sponsors of the Connect for Health Act, a broad telehealth measure that was unveiled in November 2019. Johnson said that prior to the pandemic, there was still some question as to whether telehealth works, and that the answer is “an unequivocal yes.”
Medicare claims skyrocket
Broadband access is still an issue in many areas, but Johnson said that while there were only 500 or so telehealth visits billed to Medicare in the week of Jan. 15, 2020, that number had risen to 150,000 by the week of April 15. That increase, Johnson said, “is proof positive that cutting back on Washington red tape … makes a difference to the American people.”
Johnson vowed to continue to work on permanent changes to Medicare coverage and related regulatory matters, adding that other members of the legislature will be convinced to support those changes when they hear from constituents and HCPs.
“I don’t think there is a lawmaker or a decision maker from the local, state and federal level … that doesn’t understand that access to broadband and high-speed internet is as important in the 21st Century” as access to electricity and plumbing, Johnson said. He said he has been aware for some time that government barriers, such as Medicare coverage/reimbursement, broadband licensing and certification, were the primary impediments to telehealth utilization. “It’s going to be a much easier to sell going forward,” thank to the pandemic, Johnson stated, which he described as “a silver lining in a very dark cloud.”