AT THE OUTSET of the pandemic, payers, policymakers, and providers at the local, state, and national levels rallied to rapidly expand the financial and technological infrastructure around telemedicine services. Such coordinated responses were critical to ensuring sustained, high-value, high-quality care for patients across our nation. Massachusetts specifically engaged several future-oriented telehealth services to better serve the needs of the Commonwealth.
During the COVID era, key changes supporting greater telehealth use arose from several critical developments. Improved technological access to wearable devices facilitated rapid medical responses for vulnerable populations. Policy changes loosened up regulations around prescribing controlled substances, waived co-payments and co-insurance for many types of telehealth care, reimbursed for audio-only and video visits, and relaxed prior authorization policies.
In addition, operational changes in clinical practices allowed for providers to better integrate telehealth into their practices and forge collaborations with community-based programs to increase telehealth uptake.
In 2021 Massachusetts passed a framework extending coverage for telehealth services. However, parity in reimbursements or the degree to which providers are paid to conduct telehealth visits for various appointment types is scheduled to change over time. Notably, behavioral health service payment parity is scheduled to continue permanently – representing an opportunity to understand the impact of such reimbursement structures on cost, quality, and access to mental health.
Many of these flexible changes were tied to the formal existence of a declared COVID-19 public health emergency. As we approach the anticipated end of the emergency, we also arrive at a moment of decision-making around policy issues affecting the future of telehealth. The greater the period in which we do not necessarily study or change policies and practices around telehealth, the greater the risk that inertia will chart a course for us. The path forward is littered with pitfalls, but also with incredible promise. We propose some steps to minimize pitfalls.
First, it is necessary for Massachusetts to consider the technological infrastructure underlying telehealth care to bridge the “digital divide.” In April 2021, roughly 30 percent of Massachusetts households with incomes below $35,000 did not have broadband access while 3 percent of households with incomes greater than $75,000 similarly lacked such services. Investing to close this gap is critical – particularly because these represent populations most likely to experience intersectional disparities in health outcomes.
Driving down the cost of broadband may also be achieved via public sector investment through increased enrollment in public benefit programs, including the Biden administration’s broadband access program. Enhancing competition and expanding high-speed networks could also play a role. At the patient level, Massachusetts can lead the way in publicly funded efforts towards patient and provider education regarding telehealth and ensuring e-health literacy for all residents of the Commonwealth.
Second, it is necessary to better align state policies around providing care across state lines with other parts of the country. Throughout 2022, Massachusetts permitted physicians in other states to receive emergency temporary licenses to practice within the state. Maintaining, expanding, or adapting this program may allow for opportunities to meet critical healthcare needs by utilizing the wealth of talented providers across the US. Massachusetts can take the lead on working with other states on telehealth licensing reciprocity so that both Massachusetts and other state clinicians can support patients across the country with telehealth solutions. Owning this process and negotiation with other state governments could provide a future model in how states work together to better expand healthcare to those in need.
Third, it is necessary to ensure sustainability for telehealth services by creating financial reimbursement policies which support parity for telehealth services. As suggested by a recent Health Policy Commission commission report, parity for telehealth payment should be maintained for now, while details about overhead costs and whether telehealth could help reduce overall medical spending are clarified over the next few years.
However, telehealth may not be the panacea to fix healthcare as we would like it to be. A recent study showed that private insurers paid nearly the same for telehealth and in-person visits during the early days of the COVID-19 pandemic – calling into question cost-cutting claims. Further, it is necessary to understand the return on investment based on specialty type, care setting, appointment type, and, most importantly, how telehealth affects the quality and outcomes in the care delivered.
Telehealth, as we currently understand it, cannot replace in-person visits. However, its potential lies in its capacity for augmenting and enhancing the ability of clinicians to reach and treat many more patients – particularly those who traditionally face challenges in accessing health services. Telehealth offers improved access, convenience, travel costs, and safety to both patients and clinicians. To continue to realize these advantages, implementing financial parity for telehealth will be key to maintaining the infrastructure and use by both clinicians and patients.
The pandemic showed that telehealth works, and it works well. Today, in 2023, technology is not the barrier to access health care. The barrier will be the policies dictating what happens to telehealth in the future.
Jarone Lee is a doctor at Massachusetts General Hospital and cofounder and president of Health Tech Without Borders, Inc. Aditya Narayan is a medical student and Knight-Hennessy Scholar at the Stanford School of Medicine.