COVID-19: Effects on Digital Reimbursement

Although we are still in the midst of the global pandemic, one thing has already become perfectly clear – the heightened need for digital and remote health technologies.

Color headshot of Greg SchneiderGreg Schneider, TTi Senior Advisor in Reimbursement and Market Access, answers some of your questions on the evolving reimbursement landscape around digital and remote technologies, and provides some suggestions for continued success in a post-pandemic marketplace.

What changes have you already seen and what will be the biggest changes in reimbursement post pandemic?

Payers have “temporarily” expanded the use of digital tools such as telehealth and remote patient monitoring due to the social distancing requirements of COVID-19.

Providers are utilizing these technologies to satisfy patient needs, capitalize on relaxed regulations and receive adequate payment.

Patients may be turning to these technologies for the first time so demand is sure to increase in the post-virus world.

The hope is when new data exist to prove that these digital tools were appropriate, efficient and effective during the crisis, payers will provide them “permanently” for all appropriate health conditions as part of the covered benefits offered to patients. Also, these services provided via non-face-to-face technologies should continue to be reimbursed the same (parity) as in-office/face-to-face services.

  • Medicare – In total, qualified healthcare professionals can provide almost 200 procedures to approximately 45M seniors via telehealth technology and these procedures must be reimbursed in the same amount (parity) as in-office visits/face-to-face. Prior to the pandemic, Medicare severely limited where and when telehealth could be used.
  • Medicaid & Children’s Health Insurance Programs (CHIP) provide coverage for 71 million Americans, including 35 million children. Given that each state administers its respective Medicaid program differently, with a combination of both state and federal funding sources, CMS recently provided states with a toolkit to expand coverage and reimbursement of telehealth services including remote patient monitoring. Prior to the pandemic there was no uniformity in the telehealth services covered and this toolkit provides states with a strategy forward.
  • Private payers are providing coverage in excess of 150M people through employer-sponsored policies. Prior to COVID-19 almost 75% of states had telehealth parity laws that require private insurance companies to reimburse providers for care delivered remotely via telemedicine. Because of the pandemic most, if not all, states require some form of telehealth coverage.

What do you think medtech companies should be doing right now to position themselves for the post-pandemic marketplace?

Embrace digital tools, technologies and communications and own your data. If you are using digital tools for the first time or the hundredth time, collect real world evidence to demonstrate the value of your product in terms of reduced costs, improved outcomes, and enhanced patient, provider and caregiver satisfaction. Use that data to help secure payer coverage, coding and reimbursement.