Health plan leaders request inclusion of audio-only telehealth visits to MA risk adjustment
The groups said the move is imperative to ensure health costs are captured adequately and premiums remain stable.
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Healthcare industry leaders such as AHIP, the Alliance of Community Health Plans and Blue Cross Blue Shield Association have sent a letter to the Centers for Medicare and Medicaid services requesting that the agency allow audio-only telehealth to be included in Medicare Advantage risk adjustment.
The groups said that allowing MA plans to submit diagnoses from all telehealth services for risk adjustment is "imperative" to ensure that health costs are adequately captured, premiums are stable and benefits are preserved.
Including all encounters in risk adjustment also provides clinical care teams with the information necessary to comprehensively manage their patients' care, the letter stated.
It went on to say that, without the complete and accurate documentation of diagnoses, MA plans are experiencing reductions in payments, leaving health plans and providers with fewer resources and potentially exposing patients to reduced benefits, higher premiums and increased out-of-pocket costs in the future.
WHAT'S THE IMPACT?
For both 2020 and 2021, CMS allowed MA plans to use video-enabled telehealth visits to document health acuities of seniors. To date, though, it has not extended this flexibility to audio-only telehealth encounters, which health leaders said created "unnecessary inequity" in certain communities.
"Allowing MA plans to submit diagnoses from all telehealth services for risk-adjustment is imperative to ensure that health costs are adequately captured, premiums are stable and robust benefits are preserved," the letter read. "Including all encounters in risk-adjustment also provides clinical care teams the information necessary to comprehensively manage their patients' care."
AHIP, ACHP and the other signees said the current risk adjustment model exacerbates inequities in rural and minority communities, and disproportionately impacts the socioeconomically disadvantaged, elderly and medically fragile, all groups that are less likely to have access to the necessary technology.
According to CMS data, 40% of MA enrollees earn less than $25,000 annually, and of those, 35% do not have access to broadband internet in their homes – necessitating audio-only healthcare interactions in many cases.
Among Medicare beneficiaries who used telehealth during the pandemic, 56% report using audio-only modes to receive care, and the rates were even higher among those ages 75 and older (65%), Hispanic Americans (61%), rural beneficiaries (65%) and dually-eligible beneficiaries (67%).
"Not allowing the health status of seniors who have utilized audio-only services for risk-adjustment provides an incomplete picture of the health of the Medicare population and unintentionally makes seniors appear healthier than they are," according to the letter.
THE LARGER TREND
In March, AHIP praised the introduction of a bill that would improve access to audio-only telehealth for seniors in MA plans. According to Rep. Tony Cárdenas, D-Calif., one of the bill's cosponsors, the Ensuring Parity in MA and PACE for Audio-Only Telehealth Act would allow providers to offer audio-only telehealth services to MA enrollees. It would ensure that providers are adequately compensated by requiring MA plans to reimburse them for audio-only telehealth visits as if they were in-person visits – unless both parties have agreed to a separate payment policy.
AHIP said at the time that phone calls are often the only option for seniors seeking care at home. During the COVID-19 pandemic, this demographic in particular has increasingly relied on telehealth to safely access their care, but many seniors in rural and urban communities still struggle with a lack of broadband Internet services.
While the increased use of telehealth during the pandemic allowed many patients to maintain access to care, reimbursement for a large portion of these visits may end with the public health emergency, which would create challenges for low-income patients who rely on such services, according to a February study from RAND.
The study looked at data from billable outpatient primary care and behavioral health visits at 41 federally qualified health centers that operated at 534 locations in California from February 2019 to August 2020.
During the pandemic, the FQHCs experienced a rapid increase in telehealth usage as the clinics substituted in-person care for video and telephone visits. For primary care visits, 48.1% occurred in person, 48.5% via telephone and 3.4% via video. Comparatively, for behavioral health visits, 22.8% occurred in person, 63.3% via telephone and 13.9% via video.
Telephone visits peaked in April 2020, comprising 65.4% of primary care visits and 71.6% of behavioral health visits, according to the study.
Twitter: @JELagasse
Email the writer: jeff.lagasse@himssmedia.com
