Will These Post-Pandemic Health Care Changes Stay?
Access to health care has long been a major concern for many Americans. Did the pandemic change that? It’s complicated. But we have every cause to believe that the difficult experience of the past year will shape the future of U.S. health care in several positive ways.
Telehealth took center stage during the pandemic. The technology has been around for years, but it was inconvenient and unnatural, not least because its spread was hampered by regulations, including narrow definitions of what qualified, location restrictions, and limited reimbursement procedures.
During the pandemic, regulations were relaxed, putting providers just a phone call away and allowing programs like Medicare to reimburse providers for those encounters. For many patients stuck at home, telehealth was the only way to get a new prescription or see a doctor. A fringe option became the norm.
Many of those regulatory relaxations are temporary. As states of emergency expire, old regulations will snap back into place, potentially preventing the reimbursement of services rendered over the phone or videoconferencing apps. Legislators are taking steps to codify the changes, with some success. A number of states, including Colorado, Maryland, and Idaho, have enshrined some of the temporary regulatory changes into law, and many more are in the process of doing so.
If telehealth remains mainstream, it will usher in a genuine health care revolution. This hinges on reforming not just telehealth itself, but also full practice authority and multi-state practice.
Telehealth enables users to access a nationwide network of potential providers. While these can be physicians, in many cases, a nurse practitioner or a physician assistant can do just as good a job. These non-physician professionals are often capable of working safely and autonomously without relying on the expertise of a medical doctor.
This is what full practice authority is about. Non-physician medical professionals — particularly advanced practice nurses — receive increasingly rigorous training, and states are moving to expand their authority to reflect this. Currently, 22 states have granted full practice authority to advanced nurse practitioners while 11 states explicitly restrict their ability to offer some medical services.
Several academic studies show that patients are not made worse off when treated by advanced practice nurses. Even more important, the states that have relaxed practice restrictions have been shown to have improved access to care for patients in rural and underserved areas. In many studies, the substitution of doctors with nurse practitioners results in lower cost but increased utilization of medical care.
The last piece of the puzzle is multi-state practice. The current medical licensure model limits the pool of available medical professionals. Even if you use telehealth, you can be limited to the providers in your own state. As states remove licensing barriers, patients should be able to shop across the entire country for certain health care services, much like they do when making online purchases.
Because telehealth is increasingly akin to a commodity, this reform could make care a lot more affordable. Call it “on-demand health care.” Patients get it whenever, wherever, at the lowest offered price. Acquiring the necessary technology can be a sizable investment, but in the long-run, telehealth is cheaper than in-person services that require brick-and-mortar locations.
Of course, not all health care can be delivered remotely. Telehealth works best for benign conditions, follow-up appointments, and behavioral health services. Some conditions still require a trip to the hospital or an in-person doctor visit, as do surgeries and other screenings and treatments.
The two types of care — commodified, remote care vs. complex, urgent services — call for different methods of payment. We shouldn’t need health insurance to buy highly standardized, low-risk services that aren’t very expensive. Taking these out of insurance plans would trigger a significant drop in premiums.
On the other hand, urgent care and technical surgeries require the attention of highly skilled physicians and expensive devices. Since they arise unpredictably and tend to be expensive, they are best financed through insurance.
However, the prospect of this new advent for health care is already under threat.
If you used telehealth over the past year, you likely did so through your health plan. Insurance companies were eager to pay for telehealth services because they need to prove to employers why plans are worth thousands of dollars per employee. If employees bypass insurance and purchase telehealth directly, insurance companies would soon look unhelpful. Direct-to-consumer services such as Teladoc charge an average of $35 per visit — significantly less than monthly insurance premiums.
Health plans are rapidly securing deals so that patients don’t go it alone — and so we don’t see the true cost of the services. This threatens our ability to capitalize on telehealth’s cost-saving potential.
Another threat is the mounting pressure to pass state “payment parity” laws, which mandate that public and private insurance plans reimburse providers for telehealth services at the same rates as they do for in-person care. While it will help bring more providers on board, it will ultimately drive telehealth prices upward and quash the tremendous cost-saving opportunity.
As we look to “build back better” in the wake of the pandemic, let’s acknowledge what’s been made possible by telehealth and tap into its potential. That means allowing the health care market to adapt and leaving behind old, one-size-fits-all approaches to insurance.