Milbank Memorial Fund Releases Issue Brief on Policy Landscape of In-home Telehealth

Original Source: Center for Connected Health Policy


In August, the Milbank Memorial Fund released an issue brief on the telehealth policy landscape, emphasizing the growth of synchronous, live-video telehealth delivered in patients’ homes and other nonclinical settings. The issue brief outlines the current state of home-based telehealth, differentiating between direct-to-consumer telehealth, which is commonly used to address minor and acute conditions using a patient’s personal devices, and in-home telehealth visits from a patient’s primary care provider, which are typically conducted for more serious conditions and may require more extensive technological components.

Due to the limitations of extant research on telehealth in the home, interviews were conducted with multiple state Medicaid programs, Medicare, and health care organizations that provide telehealth services. The interviews revealed that payers primarily used four model approaches to providing telehealth services at home or in nonclinical settings. These approaches include outsourcing all telehealth resources (through contracts with external vendors), outsourcing only telehealth technology, internally building telehealth infrastructure, and covering telehealth services through reimbursement policies. The latter approach was used only by Medicaid and Medicare. Additionally, each state’s Medicaid program was shown to cover home-based telehealth differently, whether through statute, regulation, or another policy mechanism.

Reimbursement from state Medicaid programs was found to often be the same amount as would be reimbursed for an in-person clinical or primary-care service, although policies do vary. In contrast, commercial coverage is dependent upon state laws and third-party vendors. Not all states require private payers to reimburse for telehealth services delivered to a patient’s home and rates for reimbursement are negotiated between private payers and telehealth providers. Private payers’ policies may also affect how in-home telehealth can be delivered. For example, Anthem reimburses telehealth only through a plan-approved telehealth program provided by a vendor or when coverage is mandated by state or federal law. The issue brief recommends that policymakers should consider the following when developing and implementing programs for telehealth:

  • Patients and clinicians are often responsible for obtaining telehealth technology. Policy should help mitigate potential issues related to patient safety, privacy, and access to telehealth services.
  • Low-income and vulnerable populations, who may not have sufficient connectivity in rural and underserved areas, may face additional barriers to appropriate telehealth use, compared to other populations.
  • Medicaid programs do not currently have methods to track and monitor the use of telehealth in the home.
  • To reduce the potential for care fragmentation and impeding coordination of care, telehealth services should be coordinated with other health services.
  • Future research is needed and program evaluations are necessary to measure the success, feasibility, and sustainability of telehealth in the home and other nonclinical settings.

The full issue brief is available through the Milbank Memorial Fund website