Why payers are picking up the tab for telemedicine


mHealth News - A new partnership between a small Utah health plan and a telemedicine provider may signal the growing acceptance of telemedicine in the payer community.

Arches Health has forged a deal with TruClinic, also based in Salt Lake City, that makes TruClinic's web-based platform available to some 1,000 Utah providers and health plan members inside the Arches Preferred Care Clinics program. More significantly, the independent payer has created 30 CPT codes "specifically for reimbursement of patient-centric care solutions that streamline the channels of care for both the patients and the providers."

Essentially, Arches is creating a payment formula that targets telemedicine, and it's including benefits that many other payers don't cover, like telephone and online consultations, group visits and a wider range of preventive services.

"Arches Health Plan has activated over 30 CPT codes to pay providers to be more proactive and practical in how they treat patients," Arches co-founder Josh Nelson told mHealth News. "Examples include payment for telephone visits, online consultations and group visits, as well as analysis of patient data to proactively identify those needing to be seen, and even to hold care coordination team conferences with family members and other specialists."

"Providers like being paid for activities they know are best for patients, but which are not paid by traditional insurance plans," Nelson added. "Patients like having easier access to their providers, test results, and follow-up questions."

Company officials said they've modeled the two-year-old consumer-oriented and operated health plan with an eye toward payment reform. Telemedicine, in fact, was built into the payer's original business plan, according toGlen Herzberg, a marketing research analyst for the health plan. 

"Really, it's just allowing people to access their doctors," he told mHealth News. "From the beginning, we've been dedicated to changing the atmosphere of payment and treatment."

Arches executives have big plans for their new partnership. They're allowing providers to make the service available to non-Arches members until September, and expect to have more than 4,500 providers in their network on the TruClinic platform in time.

TruClinic was launched roughly four years ago by Justin Kahn, and gained a foothold in 2012 in providing a telehealth platform to several Native American tribes in and around Utah. The company also has partnerships with the University of Utah Health Care and Utah Valley University, and more recently joined forces with the Zahra Charity to bring telehealth services to Morocco.

In a 2013 interview with mHealth News, Kahn said his goal was to "provide a service that eliminates as many barriers of entry as possible into telehealth."

For providers, one of the chief barriers is reimbursement. Indeed, Kahn said in a prepared statement that TruClinic is hoping that what Arches accomplishes "will resound across the country," as the plan establishes a spectrum of telemedicine services and best practices.