Telehealth During a Time of Crisis: Medicare Experiences Amid COVID-19
The COVID-19 public health emergency (PHE) has challenged health care payers and providers to address new and urgent demands, creating misalignment in supply, demand, and expertise across provider types, facility types, and state lines. It has also created the need for new and innovative approaches to serving individuals in their homes, particularly Medicare beneficiaries who have been considered at greatest risk.
The Better Medicare Alliance commissioned ATI Advisory to conduct a study on the role of telehealth and virtual care in meeting the needs of Medicare beneficiaries during the PHE. Through survey analysis and stakeholder interviews we found that:
- Nearly a third of the Medicare population likely does not have internet access in the home, with this rate growing dramatically as an individual ages, has lower income, or lives in a rural area of the country. The lack of internet access can create disparities when telehealth is limited to interactive, video-based methods.
- Risk-bearing providers are well-positioned during the PHE to modify workflow and serve patients virtually in the home. Capitated payments from Medicare Advantage plans to these providers has afforded flexibility to deploy innovative solutions.
- Medicare Advantage plans have leaned on quality improvement activities to offer virtual care solutions to plan enrollees during the PHE, due in part to process rigidity associated with supplemental benefits.
- Emergency policy waivers of long-standing fee-for service (FFS) provisions have been instrumental in expanding access to care during the PHE. However, these provisions generally have stifled further growth in telehealth in both the FFS and Medicare Advantage programs, by deterring providers from investing in telehealth infrastructure.
Telehealth and virtual care have been critical to preserving and even expanding access for some Medicare beneficiaries during the COVID-19 public health emergency. Policymakers should build on this momentum by updating outdated policies and permanently authorizing many of the waivers permitted during the PHE.