Industry Insights

June 15, 2020

LHC Virtual Panel “Managed Care and Reaching Patients in the New Normal”

LHC Virtual Panel “Managed Care and Reaching Patients in the New Normal”

Written by Alexis Simms, communications coordinator, Nashville Health Care Council

­­On May 19, Leadership Health Care hosted a virtual panel discussion, “Managed Care and Reaching Patients in the New Normal.” This discussion was held between Robert Garnett, President and CEO, Amerigroup Tennessee and Nesrin Tift, Member, Bass, Berry and Sims.

Tift spoke first, describing the rapid expansion of federal payment policy for telehealth since the pandemic began in March, saying “Today the Medicare payment policy for telehealth is truly a different world from where it was pre-March 15.” After this, Garnett discussed national and then state trends that Anthem is seeing towards usage of telehealth and telemedicine noting there has been “a dramatic shift in a short amount of time.”

Tift stated that prior to the onset of the Public Health Emergency (PHE), the Centers for Medicare and Medicaid Services (CMS) payment policy for telehealth has historically been restrictive. An interesting moment that may have been news to LHC members, was that pre-pandemic Medicare fee for service for telehealth was limited to patients who were in rural areas or health professional shortage areas. Tift said one of the biggest shifts since the PHE began is that Medicare will pay for certain telehealth services regardless of the patient’s location. CMS has also expanded the types of services that may be provided via telemedicine, such as emergency department visits, and the types of practitioners that can furnish care remotely.  State law and Medicaid policy changes have further relaxed restrictions allowing physicians to reach more patients remotely during the PHE.

While discussing the steps that Anthem is taking towards ensuring that they are reaching all their members, especially those who are most at-risk. Garnett highlighted the fact that the pandemic has exacerbated mental and behavioral health conditions, to that end, Anthem in tandem with other national and local partners has put together tools to help people stay connected while still being cognizant of social distancing. During this time, Anthem is making a tremendous effort to ensure that the most at-risk do not fall through the cracks, they are doing this in a variety of ways such as: waiving cost-sharing for virtual visits,  partnering with Lyft to offer non-emergent rides to the doctor, creating a member check in program that is geared towards 17,000 of their most at-risk members, allowing them to make connections with social services.

As the discussion wrapped, the question on everyone’s mind was whether the enhancements to the Medicare Fee for Service and telehealth will stay around after the pandemic is over?

Tift was cautiously optimistic that certain CMS payment restrictions will continue to be waived or lifted, but was less convinced that state medical boards and licensure agencies will continue to allow out of state professionals to treat in state patients and prescribe medications without face to face visits.

Garnett said, “It’s still too early to tell, but it will be different than what it looked like before. This pandemic has given us a two-month incubator of what has worked and what has not, in regard to telemedicine.  At the end of the day, the consumer drives a lot, including the demand for telemedicine. Some loved it and expect to have continued access to it. It would be challenging to take something like this added benefit away in the future. We will see a different consumer expectation and it will be interesting to see how these decisions are made at the state and federal level.”

At the end of this discussion Garnett and Tift left LHC members with a little more knowledge around managed care and how to reach patients in this new normal.

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