Population Health Insights

Is Telehealth Covered by Medicare and/or Private Insurance Companies?

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People Together-8.jpgAs remote patient monitoring (RPM) and telehealth gain greater acceptance throughout the United States (and globally), more people are wondering just what level of access they have to these groundbreaking innovations in care. More health providers and caregivers are asking questions like:

  • Will insurance pay for a remote patient management program?
  • Does Medicare cover telehealth?

Read on for a rundown of just who pays for telehealth and RPM in the U.S. — and why. (Or click here to learn exactly what telehealth and RPM are, and how they’re different from one another.)

Who Pays for Telemedicine/Remote Patient Management Programs?

VIDEO: Who Pays for Telehealth?

So, who exactly pays when telehealth and RPM programs are utilized? The simple answer is: any organization that carries financial risk or wishes to drive quality improvements.

These organizations — which include not only such entities as insurance companies, hospital systems, and specialty clinics, but also Medicare — are likely to invest in RPM because doing so tends to drive down the cost of utilization, thereby lowering costs.

Insurers as well as Medicare Advantage Plans are increasingly covering RPM in an effort to reduce utilization and “push more care into the community,” explains Marcus Grindstaff, COO of Care Innovations®, in an exclusive RPM Academy video. “You can also look at organizations like independent physician groups who are looking to reduce their overall cost structure and deliver higher quality to their patients.”

And how do telehealth and RPM reduce costs, exactly? Health systems “use remote patient monitoring to move more care out of their traditional setting and … deliver care within their entire community,” Marcus continues, “in order to reduce utilization in the hospital” in overcrowding situations.

Do Medicare and Insurance Cover Telehealth?

VIDEO: Do Private Insurers Pay for RPM?

As evidenced by the achievements of UMMC’s Mississippi Diabetes Telehealth Network — powered by Care Innovations own Health Harmony RPM platformRPM has been shown to drive down costs by improving results and quality of care. Medicare and insurance providers are taking note, and thus beginning to expand their coverage of telehealth programs, as well.

After all, it’s in the interest of both their members and their own financial stake to do so. From a quality perspective, insurers and Medicare are looking to ensure that patients “who are either being discharged from a hospital or managing chronic conditions have a continuous interaction with their health system as well as their health plan,” as Marcus explains in another RPM Academy video. This eliminates gaps that have traditionally appeared in the healthcare network after patient discharge.

VIDEO: Does Medicare Pay for RPM?

“In our healthcare system in the United States, we have to figure out a way to drive down costs,” comments Care Innovations Chief Clinical Officer Julie Cherry, RN, MSN, in an RPM Academy video addressing Medicare telehealth coverage.

RPM care does exactly that, she explains, giving caregivers and insurers a means to:

  • Drive down costs
  • Help patients avoid high-cost emergency rooms, ICUs and long hospitalizations
  • Help discharge acutely ill patients from the hospital earlier thanks to improved management and monitoring

“Do you want the patient to decide when they have to interact with the healthcare system and then call 911 and then go by ambulance?” Julie asks. “Or do you want to be able to arrange for their daughter to take them to the doctor's office two days prior to that, because they're having signs that they're not well?”

It’s hard to argue with that line of reasoning. And that, along with the basic fact that patients prefer treatment at home, is largely behind the current motivation of lawmakers to expand Medicare coverage: Although about half of all states have enacted some kind of regulations to allow telehealth reimbursement, many more have yet to do so.

The CONNECT for Health Act, currently making its way through the U.S. Congress, seeks to expand telehealth Medicare reimbursement in states that don’t currently offer it, as well as to increase access and reimbursement across state lines. Read more about the ongoing legal efforts to expand Medicare telehealth coverage here.

We invite you to learn more about telehealth, remote patient monitoring, and the many other aspects of health technology at the Care Innovations RPM Academy, a series of exclusive, highly informative videos designed to shed light on these important terms. You can also contact a Care Innovations representative for further information.
View More Telehealth Videos at the Care Innovations RPM Academy