Reimbursement rules drive telehealth innovations


As the pandemic becomes rampant, telehealth is also evolving, as providers address the limitations of video visits by adding connected digital devices and emphasizing remote patient monitoring (RPM) and the emerging field of digital therapy, focusing on remote intervention.

These are the next steps needed to make the rise of telemedicine a permanent reality given the time and cost savings it provides to patients and providers, closing the last mile of telehealth.

Some recent developments show the creative ways in which video medical visits can provide treatment. Among the early entrants is Akili Interactive, which in late May announced a partnership with gaming platform Roblox to introduce Akili’s EndeavorRx treatment for children with attention deficit and hyperactivity disorder (ADHD).

Approved by the Food and Drug Administration (FDA) in 2021, EndeavorRx is both a game and a therapy to improve attention span.

According to a May 26 press release, through this partnership, “Akili and Roblox are introducing new ways for medicine to integrate into patients’ lives. Initially, the companies will establish an exclusive Roblox rewards exchange tied to Akili’s EndeavorRx treatment… The companies are exploring new approaches and additional opportunities to engage Akili patients through Roblox integrations.

A three-month prescription for EndeavorRx costs $99 or less depending on insurance.

In May, digital therapy company Sidekick Health announced it had raised $55 million in Series B funding to further develop its solution that focuses on behavior modification to improve chronic diseases such as diabetes, ulcerative colitis and peripheral arterial disease.

“By harnessing the power of technology, we have a unique opportunity to deliver personalized treatments through smartphones and other mobile devices, empowering people to take control of their own health,” said co-founder Dr. Tryggvi Thorgeirsson, in a press release.

Sidekick Health also announced the “launch of an integrated digital therapeutic solution to improve outcomes for patients with atopic dermatitis (AD) in collaboration with Pfizer,” according to a press release, which noted that “one of the challenges effective treatment of AD is that patient adherence to treatment tends to be low.Sidekick’s digital therapy platform addresses this problem using the principles of gamification, behavioral economics and artificial intelligence (AI). ) to deliver treatment through dynamic care pathways that help inspire lasting behavior change, positively impacting health outcomes.

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Paying for “fundamental” telehealth

Remote Patient Monitoring (RPM) is an enabling technology that works with digital therapeutics to track disease states and uses that patient data to refine treatment.

With the current COVID-19 public health emergency set to end in July, proponents of continued and increased use of telehealth argue the technology has proven invaluable after its pandemic performance. The American Medical Association (AMA) is helping lead efforts to get Congress to extend telehealth payments and make coverage permanent by 2024.

In a letter to lawmakers earlier this year, the AMA said, “Virtual care is now a fundamental part of the American healthcare system, and it will improve patient access to high-quality care far beyond the COVID-19 pandemic. And while many of the most compelling clinical use cases for virtual care are only emerging now, more communities than ever have experienced the powerful impact of telehealth in closing gaps in care caused by labor shortages. -mental health workforce at the crisis level.

How patients pay and doctors and clinicians are reimbursed for telehealth services remains a sticking point as government agencies debate its permanent addition to Medicare Advantage for the elderly, while private insurers watch. the Centers for Medicare & Medicaid Services (CMS) for clues about how telehealth will be handled after the emergency is over.

Earlier this year, CMS released a Medicare Update Physician Fee Schedule on Telehealth, stating that “beginning with the official end of PHE for COVID-19, you may be able to continue to offer these services as as telehealth services. Previous telehealth restrictions limiting mental health telehealth services to only patients residing in rural areas no longer apply.

“Patient visitation to the ‘home sites’ of a physician’s office, hospital or other medical care facilities, for telehealth, will also expand to include the patient’s home,” adds the update. “In CR 12519, we clarified that the patient’s home includes temporary accommodations such as hotels, homeless shelters, or other temporary accommodation located a short distance from the patient’s actual home, where the “expenses of ‘establishment of the site of origin’ do not apply. ”

See also: As telehealth peak slows, vendors seek innovation to increase engagement and new use cases

Removing restrictions around where telehealth visits originate for billing purposes means more Medicare patients can continue to receive covered telehealth visits. As RPM devices and digital therapies advance, it is expected that telehealth can actually intervene rather than just monitor and diagnose.

Integrating telehealth costs into coverage will go a long way to improving and evolving the modality.

According to “The Telehealth Digital Payments Report,” a collaboration between PYMNTS American Express, “Costs have continued to be a barrier to consumer telehealth access over the past 12 months. One-third of consumers said they withdrew from necessary appointments or abandoned necessary medical treatment, primarily for cost-related reasons: 43% of those who withdrew from visits were concerned about cost, 40% said they could not afford the care or treatment. and 26% said their insurance would not cover the visit.

Get the report: The Telehealth Digital Payments Report



About: PYMNTS’ survey of 2,094 consumers for The Tailored Shopping Experience report, a collaboration with Elastic Path, shows where merchants are succeeding and where they need to up their game to deliver a personalized shopping experience.


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