As we promised, below is this information from our You Tube Presentation.
TELEHEALTH YOCAREU TUBE HAND OUT
What is Telehealth and Telemedicine?
There’s an old proverb, “Necessity is the mother of invention.”
Never has this been truer than describing the emergence of telehealth and telemedicine. In our opinion, three developments accelerated the rapid rise of telehealth and telemedicine. First, the internet, second the COVID epidemic and finally the passage of the Cares Act and CMS 1135 Waiver. Up until COVID, the medical community was very lukewarm on the idea. The reason was quite simple. Fear by incumbent providers of new providers stealing their business. COVID, however, completely changed the environment from admitting patients and seeing patients in physician offices to keeping patients out of hospitals and out of physician offices unless absolutely necessary. And all of a sudden, telemedicine became the answer to the challenges.
What exactly are telehealth and telemedicine? The American Academy of Family Physicians (AAFP) define telemedicine “is the practice of medicine using technology to deliver care at a distance, over a telecommunications infrastructure, between a patient at an originating (spoke) site and a physician, or other practitioner licensed to practice medicine, at a distant (hub) site. Telehealth refers to a broad collection of electronic and telecommunications technologies and services that support at-a-distance healthcare delivery and services.” According to the AAFP “telehealth is different from telemedicine in that it refers to a broader scope of remote healthcare services than telemedicine. (If one has a deeper interest in the history of telemedicine we suggest going to the internet.)
A few years ago, these were very new terms the healthcare consumer was confronted with and needed to understand. These new terms and subsequent services were starting to gain visibility and traction for the healthcare consumer due to the aforementioned situation caused by COVID. Even though the crisis of COVID has subsided telemedicine continues to grow so the healthcare consumer needs to understand what it’s all about and how it will affect management of their personal/family healthcare.
As of March 1, 2024, the five largest public telehealth/telemedicine companies by market cap are as follows:
- Doximity
- GoodRx
- Teladoc Health
- LifeStance Health Group
- Hims & Hers Health
According to the internet, the total market cap of the telehealth/telemedicine market is $16.5 billion with the global telehealth & telemedicine market in terms of revenue was estimated to be worth $120.4 billion in 2023 and is poised to reach $285.7 billion by 2028, growing at a CAGR of 23.2% from 2023 to 2028. So, it’s relatively small in the context of the entire healthcare delivery system.
Telemedicine Services
According to WebMD telemedicine is useful to manage chronic conditions. Types of care include:
- Results of lab tests or x-rays
- Manage a mental health condition
- Deal with recurring problems like migraines or urinary tract infections.
- Urgent care issues like a cough, cold or stomachache
- Managing prescriptions
- Diagnosing skin conditions
- Physical or occupational therapy
- Remote monitoring of conditions like diabetes or high blood pressure
The aforementioned are only examples and we encourage you to visit the websites of whatever companies you’re interested in utilizing.
Telemedicine Charges
Below are examples of Telemedicine Providers, their charges and the services they provide.
GoodRx Care | $19-$49 | General care | |
MDLive | $82-284 | Urgent care, general, mental health, dermatology | |
Teladoc | $75-$299 | General care, mental health, dermatology | |
Doctor On Demand | $89-$299 | General, mental health, preventative, chronic care | |
Amwell | $79 | General, mental health, pediatrics, women’s health | |
Sesame | $29-$62 | General, mental, dental, skincare, sexual health | |
PlushCare | $99-$129 | General, urgent care, mental health, sexual health | |
HealthTap | $44-$129 | Primary and urgent care, sexual health, pediatrics |
Telehealth Mental Health has experienced an increase in visits over the past several years. Telepsychiatry services will aid in the evaluation, stabilization, and disposition of a variety of mental health emergencies, including:
- Suicide attempts or self-injurious behaviors.
- Suicidal ideations
- Homicidal ideations
- Acute agitation
- Severe depressive episodes
- Manic episodes
- Acute psychotic episodes
- Severe anxiety
- Involuntary commitment evaluations/referrals
- Severe adverse reactions related to psychotropic agents
- Co-morbid substance use disorders
Regulations
Telehealth is controlled by States’ regulatory bodies. We have found two websites that track regulatory actions by state and if you have questions encourage you to review them.
- “State Policy Agenda for Telehealth Innovations”- Reason.org
- “Telemedicine Statistics 2024-Everything You Need to Know” – llcbuddy.com
Insurance Coverage
As telehealth became more mainstream during COVID, the major health insurance payors added telehealth coverage to their plans. A sample list of current payors include the following:
- Blue Cross/Blue Shield
- Aetna
- Cigna
- United Healthcare
- Oscar Health (limited markets)
In addition to the publicly traded telehealth companies, local health systems have also established telehealth services. We encourage you to check if these services are covered by your health insurance plan and healthcare provider.
Remember, Co-pays, Co-insurance and Deductibles apply to Telehaea;th Care visits.
Medicare Coverage (from Medicare.gov, “Your Medicare Coverage; Telehealth”)
Original Medicare Part B covers certain telehealth services.
After you meet the Part B deductible, you’re responsible for 20% of the Medicare approved amount for your doctor or other healthcare provider’s services.
For many telehealth services, you’ll pay the same amount that you would if you got the services in person.
To find out how much your test, item, or service will cost, talk to your doctor or healthcare provider. The specific amount you’ll owe may depend on several things, like:
- Other Insurance you have
- How much your doctor charges
- If your doctor accepts assignment
- The type of facility
- Where you get your test, Item, or service
- The type of provider
Note: Through December 31, 2024, you can get telehealth services at any location in the U.S., including your home. After this period, you must be in an office or medical facility located in a rural area for most telehealth services.
Medicare Advantage Plans
Medicare Advantage Plans and some providers, like ones who are part of certain Medicare Accountable Care Organizations (ACOs) may offer more telehealth benefits than Original Medicare. Check with your plan to find out what benefits they offer.
On the Medicare.gov/coverage/telehealth website is a box to input the test, item or service to determine if it’s covered.
What the Healthcare Consumer Needs to Know
Since telemedicine is relatively new, healthcare consumers need to ask several questions to ensure they fully understand the medical process and clearly know their financial responsibilities. The following is a guide for the healthcare consumer to utilize:
Question about Telemedicine | Consumer Action |
Does my insurance cover the service | Call your insurance company |
What services are covered | Call your insurance company |
What is my out-of-pocket expense | Call your insurance company |
Does my PCP/Specialist participate | Call your insurance company |
To conclude, telemedicine is still a relatively new healthcare service that is still evolving. Healthcare consumers need to be cautious and well informed. Healthcare consumers need to ask many questions before participating in any telemedicine services. Lastly, this new service has significant promise and should be used when appropriate.
HCNC is your healthcare partner that offers healthcare consumers information to navigate the healthcare ma HCNC is your healthcare partner that offers healthcare consumers information to navigate the healthcare maze.
Find us at : www.healthcareconsumernavigatorcenter.com