When it comes to deciding which medical services are covered by insurance, Medicare often breaks new ground with payment policies – and then private insurers follow this lead. However, as noted by a recent article in Healthcare IT News, this trend might be just the opposite for telemedicine. According to industry analysts, payers are responding to some of the limits imposed on them by the Affordable Care Act (ACA) by taking a more active role in promoting wellness and preventing complications of chronic disease – all in an effort to hold their own costs down. The article states:
From online video conferencing with a doctor to remote monitoring and alerts to patients with chronic conditions such as heart disease and diabetes, private payers are now leveraging improved technology to better manage the health of their members.
“We believe telemedicine can play a critical role in improving health and managing chronic disease, while increasing member satisfaction,” said Ethan Slavin, a spokesman for Aetna. “Telemedicine can also significantly reduce costs by reducing non-medically necessary ER visits and readmissions as members use virtual options for after-hours care and provider instruction.”
Aetna, which first jumped into telemedicine in 2006 via a partnership with RelayHealth, is not alone in its support of these services for its members. Last year, WellPoint announced it would offer online health consultations via a partnership with telemedicine company American Well; Highmark has partnered with Teladoc to provide telehealth service to a broad swath of its members; and recently Cigna announced it would provide online consultations to its members via MDLive.
Telemedicine is defined by the American Telemedicine Association as the use of medical information exchanged from one site to another via electronic communications, to improve patients’ health status. It is not considered to be a separate medical specialty, but rather a means of delivering care efficiently.
Telemedicine was first covered by Medicare only for use among specially designated rural populations that were chronically underserved and lacked access to care. In this context it made sense, as both teleconferencing and remote health monitoring technologies could be used to expand the reach of health care providers in nearby towns and large cities. Yet telemedicine was slow to catch on in a more mainstream way – largely, as American Sentinel reported in a previous blog post, due to unresolved policy issues surrounding reimbursement strategies, lack of technology infrastructure, the means to integrate data collected in the home with the medical record, etc.
Today, however, one of the primary goals of healthcare reform is to expand health care access to various populations that have long been underserved. These include minorities, rural communities, the poor, and the previously uninsured. Obviously great challenges lie ahead, as large numbers of previously uninsured people begin to seek access to primary care clinicians. Telemedicine promises to be an important tool in meeting these needs, by addressing many of the inefficiencies that are driving up costs in our current methods of care delivery. Simply put, they have the potential to keep people out of the hospital in the first place, and to improve post-discharge care when they have been hospitalized.
As reported by Healthcare IT News, 19 states currently have some kind of mandate requiring private insurers to reimburse for certain telehealth services, with many other states considering such legislation. These numbers are likely to grow, as payers find it can boost their bottom line not only to reimburse for telemedicine, but to create their own wellness programs that include such technologies.
It also may be that payers and providers alike are responding to a shift in consumer sentiment. As consumers of health care grow more tech-savvy in general, they become more comfortable with using home health devices and electronic communication methods to stay in touch with their primary care team.
So how does telemedicine affect you as a nurse? As payers and consumers increasingly see the value in telemedicine, it will surely become more widely available, resulting in expanded nursing career opportunities. Some of these opportunities will be directly related to the increased need for primary care services, but others will result from a new demand for certain key nursing specialties. For example, if you’re interested in nursing informatics, there will likely be new opportunities for you to be involved with developing and implementing new home health technologies. Case management skills will also be in demand, as the health care system seeks ways to manage a population of patients who are aging in place at home.
This may be a good time for you to develop new skills and empower yourself with knowledge through an online RN to BSN or RN to MSN degree. American Sentinel University is an innovative, accredited provider of online nursing degrees, including programs that prepare nurses for a specialty in areas like infection control and executive leadership.