Why Telehealth Does Not Increase Care Use or Cost

In HEDIS & Quality Management by Marketing

NCQA study finds telehealth use due to COVID is on the rise, but not excessive

Data collected by providers and the government so far indicate that the COVID-19 pandemic is exerting no effect on total healthcare utilization, even as healthcare facilities expanded patients’ access to telehealth resources. Despite the fear that telehealth’s increased availability would create a rush that could overtax the system and drive up healthcare costs, that has not been the case, according to a report from NCQA.

NCQA: Telemedicine as a Substitute for In-Person Healthcare Visits

There is no question that logistics and virus concerns drove up Medicare beneficiaries’ use of telehealth in the early months of the virus in the U.S. Before COVID-19, telehealth accounted for less than 1% of such visits. Now, 50% of primary care visits are conducted electronically.

“Before COVID-19, telehealth accounted for less than 1% of such visits. Now, 50% of primary care visits are conducted electronically.”

Despite this meteoric rise in telehealth, total primary care visits – telehealth and in-person – remained below pre-virus levels. “This data suggests that telehealth can be substituted for in-person care without increasing utilization,” the report states.

NCQA’s Taskforce on Telehealth Policy works to assess the impact telemedicine exerts on healthcare costs and availability. In addition to substituting for more resource-intensive personal visits, telehealth may:

  • Reduce the need for more costly care
  • Lower no-show rates
  • Facilitate transitional care management
  • Reduce the number of skilled nursing facilities transfers

Vital Data Technology’s Affinitē™ Quality™ aids health plans in prioritizing resolution of care gaps related to HEDIS quality measures that relate to telehealth.

Striving for Neutrality

As telehealth continues to gain steam, the issue of fair Medicare reimbursement will come to the forefront. The key is to ensure the telemedicine’s availability, convenience, and reimbursement schedule does not sway decisions on its use. Care providers will schedule the types of appointments that will benefit each patient the most. They should not embrace or distance themselves from telehealth because reimbursement is significantly more or less generous than in-person care, compared to the effort required.

Toward that end, Medicare should reimburse telehealth services according to several factors:

  1. The value provided, based on effectiveness and accessibility
  2. The cost of service – including the elimination of transportation, time off work, and other costs that would have to be absorbed by the care recipient
  3. Demand, as evidenced by utilization during “normal,” post-pandemic cycles

To accurately assess all three of these factors, a solution like Affinitē™ Quality™ can support the data collection by categorizing HEDIS® services delivered for accurate, real-time results. 

With access to the right data and information, care managers can track telehealth visits and identify care gaps at any point in the data reporting cycle so they can establish procedures for closing them and capturing revenue.

So as organizations move into telehealth in a COVID environment, there shouldn’t be any concerns around cost or tracking when the right solution is in place.

Keep Learning

Kelly Cieciorka MPA, HSA
Director of Quality

Kelly is the Director of Quality and Product Owner of Affinitē Quality™. She is responsible for guiding the quality product’s development and partnering with customers for successful implementation and optimization of the solution. Affinitē Quality is Vital Data Technology’s year-round HEDIS® and plan-defined quality management and submission module fully certified by NCQA for 2020 HEDIS measures.

She graduated from the University of San Francisco with a master’s degree in public administration. She has an undergraduate degree in pre-med and biology from the University of California, Santa Barbara.

Share on