Telehealth Reimbursement a Focal Point of Post-Pandemic Healthcare

October 12, 2021 - As the pandemic winds down, providers and payers are set for serious conversations about telehealth reimbursement and payment parity now that the modality has shown its real potential for improving care.

PCPs Worry About Reductions in Telehealth Reimbursement

Telehealth reimbursement is key to continuing virtual care innovation and addressing healthcare staffing issues at primary care practices, according to a new survey. Conducted by in mid-August by the Larry A. Green Center in collaboration with the Primary Care Collaborative (PCC), the survey found that primary care practices have come to rely on telehealth.

About 40 percent of primary care clinicians surveyed as part of the ongoing COVID-19 Primary Care Survey said that at least a fifth of all office visits are done through telemedicine. Additionally, nearly two-thirds (64 percent) said telehealth has been integral to maintaining access to care.

However, 41 percent of survey respondents are worried that their practice will not be able to support telehealth/telemedicine services if pre-pandemic regulations are restored. Availability of telehealth reimbursement is a major concern with the regulations, with about a fifth (21 percent) of clinicians saying their practice has already had to pull back on the use of telehealth since payments were reduced. READ MORE

Toolkit Helps Providers with Payer Negotiations for Telehealth

An organization focused on assisting healthcare providers with virtual care platforms has released a resource for negotiating third party payer reimbursement.

The Payer-V1C Contracting Toolkit is designed to support virtual-first care solutions, which have been springing up across the country in the wake of the pandemic. Many healthcare organizations shifted to telehealth to reduce in-person care during the pandemic, and some have decided to prioritize virtual care going forward.

DiME, a Boston-based digital medicine organization launched in 2019, partnered with the American Telemedicine Association to create the IMPACT (vIrtual-first Medical PrActice CollaboraTion) initiative this past January, offering support for providers who’d launched or were looking to create virtual-first platforms. IMPACT unveiled the Payer-V1C Contracting Toolkit last month.

The toolkit includes a guide to payer-V1C contracting, a guide to payment models that support virtual-first care, and a library of billing codes that address virtual-first care. READ MORE

PA Blue Turn to Apps to Tackle Type 2 Diabetes

Identifying the best app for members to use and rolling out the solution effectively are more challenging processes for insurers to navigate.

In October 2021, Capital Blue Cross strengthened its Type 2 diabetes management efforts by introducing two new apps to its members, apps that could enable them to prevent and potentially reverse the progression of Type 2 diabetes.

“Ultimately, Type 2 diabetes is often preventable and we believe easily accessible, versatile, whole-person lifestyle coaching and modification is key not only to prevent but also to help treat and reverse Type 2 diabetes,” Shelley Grant, vice president of population health at Capital Blue Cross, told HealthPayerIntelligence.

“Members with diabetes often have a variety of chronic conditions, so it’s important to have a versatile platform to help reduce the risk of comorbidities by engaging members in an active and healthy lifestyle.” READ MORE

Lack of Interest in Preventive Care Worries Public Health Experts

Only a bit more than half of US adults said they’re confident they’ll get a flu shot this year, a staggering lapse in preventive care that could be disastrous ahead of a potentially nasty flu season, researchers from the National Foundation for Infectious Diseases said.

A total of 44 percent of adults said they would not or were unsure they’d get a flu shot this year, and nearly a quarter of those at high risk for getting a serious case of the flu said they wouldn’t get a flu shot. Overall, 61 percent of adults agree that getting the flu vaccine is the best way to protect against flu infection this season; nevertheless, a sizeable portion of the population is not confident they will get the shots.

These findings are alarming, public health officials say, considering the high risk flu poses this upcoming season. Paired with the COVID-19 pandemic, experts are urging the public to get their flu shots to help stave off serious infections and potential straining of the healthcare system. READ MORE

Artificial Intelligence Assists Precision Medicine Research

Washington University School of Medicine has adopted artificial intelligence-based natural language processing tools to assist in sorting their unstructured electronic health record data and improve precision medicine research.

The school’s initial focus is on chronic diseases such as Alzheimer’s disease, breast cancer, lung cancer, diabetes, and obesity. With the AI-based tool, researchers can pull key information from electronic health records about diagnoses, treatments, and outcomes.

“Fundamentally, the challenge that we have with personalized medicine or precision medicine is that rather than treating patients as a function of how the average patient presents or the average patient may respond to therapy, we instead want to understand the individual features of each unique patient that contribute to both wellness and disease, and response to therapy,” Philip Payne, Washington University Associate Dean for Health Informatics and Data Science, told HealthITAnalytics. READ MORE

Johnson & Johnson Submits Data for COVID-19 Vaccine Booster

Johnson & Johnson recently submitted data to the FDA to support its COVID-19 vaccine booster shot in adults 18 and older.

The submission includes results from the Phase 3 ENSEMBLE study, which found that a booster shot of the vaccine elicited 94 percent protection against the coronavirus.

The most extensive real-world evidence study for a COVID-19 vaccine reported to date in the US enrolled 390,000 individuals who received the Johnson & Johnson COVID-19 vaccine versus nearly 1.52 million unvaccinated individuals.

In the trial, a booster shot of Johnson & Johnson’s COVID-19 vaccine at two months provided 100 percent protection at least 14 days post-final vaccination and 75 percent protection against symptomatic COVID-19 globally. READ MORE