Insurers generally have avoided using telemedicine providers within their provider networks, despite widespread physician shortages in some areas, according to a new study. The report, prepared by researchers at Georgetown University with funding from the Robert Wood Johnson Foundation, shows that insurers could meet new provider network size requirements by covering telemedicine—especially for consumers in rural or underserved urban areas.
Telemedicine uses technology, such as video conferencing or tools to monitor blood pressure at home, to access medical care remotely.
Through interviews with officials in six states (Arkansas, Colorado, Illinois, Maine, Texas, and Washington), researchers identified pros and cons of insurers expanding coverage via telemedicine services. The interviewees said that telemedicine could expand access to primary care, as well as specialists including psychiatrists, cardiologists, and endocrinologists, but that insurers are more likely to use it as a supplement to, not 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 the Robert Wood Johnson Foundation. “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.”
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If you would like to discuss the report or its findings with an expert, please contact Frank Walsh at 504-309-5164 [email protected].
About the Robert Wood Johnson Foundation
For more than 40 years the Robert Wood Johnson Foundation has worked to improve health and health care. We are working with others to build a national Culture of Health enabling everyone in America to live longer, healthier lives. For more information, visit www.rwjf.org. Follow the Foundation on Twitter atwww.rwjf.org/twitter or on Facebook at www.rwjf.org/facebook.
