A new decade of health care

The most obvious change, leaders say, is the speed with which carriers, doctors and patients have embraced telemedicine.

“We’ve kind of been evangelizing the concierge medicine thing for the last four or five years. Teladoc, Nurse Navigators, things of that nature, you name it,” said Kareim Cade, President and CEO of Great Lakes Benefits Group. “It just wasn’t popular. We did not have buy-in. You had 2-5% of people that would actually engage or be involved. But now with COVID, those numbers have gone up significantly.”

After years of planting seeds that seemed to bear little fruit, Cade said he’s been inundated by HR professionals asking him how employees can avoid going to the hospital and urgent care. They want to know what those services look like, and how they can get involved.

“And so now we’re receiving calls where people are saying to us, ‘Hey, you were talking to us about this some time ago. We might’ve been a little bit deaf about this in trying to figure this out, but now this is very pertinent for us.”

Many insurers have waived fees for virtual care, something that has been made possible by rapid changes in federal policies governing health insurance.

“I don’t think I’ve ever seen the feds or anybody move that quickly to rewrite actual useful regulations with that level of speed,” said Jeff Romback, Deputy Director of Policy and Planning with the Michigan Association of Health Plans. “I mean, all of a sudden you could waive copay for telehealth for all sorts of reasons that were never applicable.”

A major benefit for providers has been changes that have allowed them to be reimbursed for the same amount they would in an in-person visit.

“During the pandemic, I think every insurer stepped up to say, ‘Yeah, we’re going to pay you to keep people out of your office, which I think has been a good thing for the community,” added Sokol. “They’re getting reimbursed for telehealth visits the same way as if it was a face to face, which is normally a lower reimbursement rate.”

And health care plans are adjusting rapidly to this new reality as well.

“There are some carriers that are waiving costs of virtual visits, and that’s not only relating to COVID, but anything else as well,” said Catherine Cooper, Legislative Director for the Michigan Association of Health Underwriters. “As far as the carriers adapting to virtual visits, usually they all have a certain partner that they use for telehealth, but they’ve also expanded it that if your own doctor does a virtual visit, you can utilize that doctor and that service through your primary care specialist, and those copays get waived.”

Cade sees this as a golden opportunity to get telemedicine right.

“For those of us that have been progressive in talking about these other ideas like bundle payments, ambulatory surgical centers — people are engaged now. And I think we’ll have more opportunities to really look at the true cost, the true containment opportunities and not just talk about carrier-specific issues.”

David Sokol, President of Wilshire Benefits Group, agreed.

“I had never had a virtual visit with my primary care physician and I’ve had three over the last three months,” he said. “We’ve done some utilization reviews with our larger self-funded clients and finally we see a huge acceptance towards that delivery model, which is really necessary given the shortage of primary care physicians in America and the importance of operating more efficiently and cost effectively.”