HomeHealthcareInvestor Urge for food For Telehealth Put up-Pandemic: Alternatives Primarily based on...

Investor Urge for food For Telehealth Put up-Pandemic: Alternatives Primarily based on Medicaid and Business Insurance coverage Markets

Investor curiosity in telehealth surged in the course of the Covid-19 pandemic.  Whereas the healthcare business’s widespread adoption of telehealth was pushed by necessity because of social distancing practices, such enlargement wouldn’t have been doable with out federal and state governments waiving many authorized and regulatory necessities that had beforehand hindered such telehealth progress.  Many of those waivers had been non permanent and tied to public well being emergencies (“PHEs”) which both have already or will quickly expire.  In flip, the amount of telehealth investments has already begun to say no. Actually, 2023 is projected to be the lowest telehealth funding yr since 2019.  This begs the query – is the slowing telehealth funding as a result of tightening credit score markets and an anticipated financial downturn, or ought to the telehealth business anticipate the pattern of decreased investor curiosity to proceed in a post-PHE world?

A assessment of federal, state, and personal payer exercise signifies curiosity in telehealth stays robust.  As such, because the credit score market stabilizes and fears of a recessions start to recede, we anticipate investor curiosity in telehealth to return.

Background on pandemic telehealth protection insurance policies

Previous to the Covid-19 pandemic, payers had created quite a few coverage and protection obstacles that served to restrict widespread telehealth adoption.  For instance, Medicare had necessities stopping sufferers from receiving telehealth companies from their properties, in addition to the frequency limits of sure telehealth companies.  Many state Medicaid applications and personal payers had comparable telehealth restrictions.  On January 31, 2020, a PHE was first introduced on the Federal stage.  Pursuant to the PHE, the Division of Well being and Human Providers, Facilities for Medicare and Medicaid Providers (“CMS”) waived most of the key Medicare telehealth necessities that had beforehand restricted widespread telehealth adoption, with state Medicaid applications and personal payers shortly following CMS’ lead.

Insights on telehealth curiosity from federal, state and personal payer motion

The federal telehealth waivers had been set to finish when the federal PHE expired on Could 11, 2023.  Though CMS was supportive of constant expanded telehealth protection, many restrictions on telehealth had been set by statute, and due to this fact congressional motion was required to completely change insurance policies.  Below heavy business strain, on December 29, 2022, Congress briefly prolonged most of the telehealth flexibilities afforded by the PHE to Medicare beneficiaries by December 31, 2024.  Given the present gridlock in Congress, legislative efforts to additional codify telehealth protection enlargement are unlikely to be revisited till late 2024.  Whereas budgetary pressures could proceed to result in non permanent moderately than everlasting extensions, with CMS, business, and public assist, Congress is unlikely to pressure a return to a pre-pandemic telehealth world.

In relation to making protection determinations, states typically observe the lead of Medicare.  Nevertheless, given the expectation that Congress is not going to act additional on telehealth options till late 2024, state motion gives useful perception into the energy of the telehealth business post-PHEs.

Many state Medicaid applications supply extra beneficiant telehealth protection insurance policies which have continued to broaden within the final couple of years. States have lengthy eliminated geographical restrictions imposed on the place telehealth companies happen. Actually, Hawaii, Montana, and Maryland are the one state Medicaid applications that also limit reimbursable telehealth companies to rural areas. Moreover, 37 state Medicaid program plus Washington, D.C. enable sufferers to obtain telehealth companies of their dwelling. Eradicating geographical restrictions and growing the varieties of eligible originating websites signifies that extra sufferers, together with beforehand underserved populations, can entry telehealth companies.

With respect to the supply technique of telehealth companies, all state Medicaid applications reimburse for reside video and 36 state Medicaid applications and Washington, D.C. additionally reimburse for audio-only telehealth companies. Furthermore, 28 state Medicaid applications reimburse for asynchronous telehealth companies, additionally known as store-and-forward insurance policies, which permit suppliers and sufferers to immediately share data with one another earlier than and after telehealth appointments.  This motion by state Medicaid applications past the historic reside video necessities gives reimbursement alternatives for telehealth suppliers and expertise.  The success of such applications may additionally result in additional adoption from Medicare of store-and-forward companies (that are lined solely lined by Medicare in Hawaii and Alaska as a part of a telehealth demonstration undertaking).

States have moreover taken legislative motion to handle non-public payer reimbursement for telehealth companies. Nearly all of states have handed service parity legal guidelines, requiring telehealth companies to be lined if they might in any other case be lined if rendered in-person. Cost parity legal guidelines, which 24 states have handed, require telehealth companies to be reimbursed on the identical fee as in-person companies.

Past the versatile telehealth insurance policies offered by state Medicaid applications, states are demonstrating dedication to telehealth companies by asserting their very own investments into telehealth choices. For instance, Minnesota’s Division of Well being launched a report in June 2023 detailing how telehealth companies have crammed within the gaps of healthcare entry and supply. Different states, like Ohio and New Mexico, are increasing broadband entry to take away the technological obstacles to telehealth entry. Ohio is concentrating its broadband enlargement efforts to offering telehealth entry to Ok-12 college students and Governor Grisham of New Mexico lately introduced that part of the state’s $675 million federal grant to broaden broadband entry all through the state might be allotted to bettering entry to telehealth companies. In March 2023, Governor Roy Cooper of North Carolina issued a $1 billion funding plan to handle the state’s psychological well being and substance use disaster, which incorporates $225 million for elevating Medicaid reimbursement charges for behavioral well being companies and allocates $50 million in direction of facilitating entry to psychological well being remedy together with by telehealth for rural communities.

Non-public payer motion additionally affords helpful perception into the energy of the post-PHE telehealth market. Though non-public payers have at all times had the pliability to find out protection for telehealth companies (inside the boundaries set by legislation), their partnerships and newly added companies show dedication to protection and reimbursement for telehealth companies. For instance, BlueCross BlueShield of Massachusetts’s expanded community of psychological well being suppliers  lately expanded its psychological well being community embody telehealth companions with Headway and Talkiatry, (and has correspondingly elevated its psychological well being spend from $610 million in 2019 to $1.3 billion in 2022). Aetna gives its members entry to CVS Well being Digital Major Care, which expanded this yr to incorporate telehealth psychological well being care appointments with licensed therapists and psychiatrists. Equally, Humana continues to develop its psychological well being telehealth platform with the addition of Array Behavioral Care in February 2022 and Valera Well being in July 2023 as in-network suppliers.


However the top of PHEs and corresponding loss in lots of waivers and insurance policies that allowed for elevated telehealth adoption in the course of the pandemic, the current actions of state governments and personal payers point out that curiosity in telehealth stays robust.  We due to this fact anticipate investor curiosity in telehealth suppliers and expertise to equally keep robust as financial headwinds recede.

Photograph: elenabs, Getty Pictures

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