Massachusetts Health & Hospital Association

MHA Applauds BCBSMA Telehealth Policy

Quotation marks with an EKG symbol

Blue Cross Blue Shield of Massachusetts (BCBSMA) has taken a dramatic step that recognizes how telehealth has transformed healthcare delivery; the state’s largest insurer announced that it will reimburse for telehealth primary care and chronic condition care at the same rates as it would if the care were provided in-person.

“We applaud Blue Cross Blue Shield of Massachusetts and are appreciative that they took the forward-thinking step of leveraging the proven benefits of virtual care,” said Steve Walsh, MHA’s president & CEO. “Care is constantly evolving and the introduction of telehealth into the equation is merely another innovation designed to improve access, make follow-ups easier, and allow patients to quickly stay in touch with those keeping them healthy. Blue Cross understands the transformational promise of telehealth.”

Since the pandemic began in early 2020, providers have seen a dramatic increase in patients seeking care through telehealth. Individuals contacting their physician or other caregiver by phone or videoconference can easily access care, avoiding taking time off from work or school for an in-person visit, and reducing their transportation costs or daycare scheduling difficulties. Telehealth also provides greater access to primary care and can reduce more expensive emergency department visits.

While the venue for care may have changed through telehealth, the provision of that care – the discussions between patient and provider, the subsequent scheduling of tests and other follow up care – has not changed. And the costs of that care still exist, from a caregiver’s hours, to paying for support staff, rent, claims submission, maintaining patient records, and more. In fact, providers have invested in telehealth, shouldering the initial costs of adopting the new technology.

As the Health Policy Commission (HPC) noted in a January report, “No providers reported that telehealth had reduced their total operating expenses.” The HPC said providers face “additional expenses for establishing telehealth technology infrastructure and continued need for physical space, administrative staff, and clinician time to schedule and perform a telehealth visit as well as in-person visits.” The HPC report recommended that reimbursement parity for primary care and chronic disease management continue for at least two more years, allowing providers to continue improving their telehealth platforms and workflow, and to develop efficient hybrid care models. The HPC found that telehealth use was highest for patients with chronic conditions.

Other Plans Threaten Cuts

BCBSMA last year had considered reducing primary care and chronic disease telehealth reimbursements by 20%. Its decision this month, after further analysis, to rescind that proposed payment cut came as a welcome relief to providers. However, unlike BCBSMA, Point32Health, the parent of Harvard Pilgrim and Tufts health plans, still plans to implement a 20% telehealth cut beginning this Wednesday, March 1. Other health insurance companies may be considering or have already reduced reimbursement.

“The Massachusetts Medical Society is incredibly pleased by this BCBSMA outcome and will continue to urge all other carriers in the commonwealth to follow their lead in recognizing that disrupting the efficacy, efficiency, and momentum of telehealth threatens patient health and the attainment of equitable access to healthcare,” Massachusetts Medical Society President Dr. Ted Calianos said. “We are grateful to BCBSMA for the opportunity to represent the physician and patient voices during critical discussions about telehealth and to our likeminded colleagues from MHA and the tMED Coalition for their partnership in advocacy.”

Most telehealth is delivered through a hybrid model. That is, a practice or hospital still maintains offices, still employs staff, and still has overhead, but merely provides some of its care via telehealth. A practice may save some money by using telehealth (latex gloves and exam room table coverings aren’t needed, for example) but the overall costs of telehealth versus in-person care are on par with each other. And telehealth appears here to stay; a Massachusetts Health Quality Partners’ survey at the end of 2022 found that 81% of patients and 75% of clinicians responding believed that telehealth will be “Extremely Important” or “Very Important” to the future of care.