As Obamacare Doctor Networks Narrow, Telehealth Wants To Get In

As health insurers narrow doctor network choices to control costs for plans on public exchanges under the Affordable Care Act, they may need to break down regulations to allow telehealth providers to improve access in rural and other underserved areas, according to new research and presenters at the Association of Health Care Journalists annual meeting.

Momentum is building to give consumers more access to doctor visits via telemedicine, which offers access to physicians and patients via smart phone, tablet or computer. Employers and private insurers are embracing the trend as a way to make healthcare more convenient and avoid costly and unnecessary trips to the emergency room or a more expensive physician’s office.

Manoel Coelho of GlobalMed uses a device with a camera to look at colleague Tim White's ear, displayed on monitor, during a demonstration to NATO leaders of some of the technology and equipment options available for telehealth services June 22, 2015, at Avera Health’s telemedicine hub in Sioux Falls, S.D.

But the narrow network trend that has been fueled by employers and health plans offered on public exchanges under the Affordable Care Act may be leaving patients in underserved rural areas and inner cities with fewer doctor choices. And that, some say, is leaving telehealth providers an opening to convince regulators to make them part of ACA-compliant networks.

“With the trend toward stricter definitions of network adequacy in states, there may be ways that telemedicine can help carriers demonstrate that they are providing adequate access to their members,” Kathy Hempstead of the Robert Wood Johnson Foundation, which funded a Georgetown University study on network adequacy, said in a statement accompanying the report.

Health plans that operate on exchanges including

, UnitedHealth Group and Blue Cross and Blue Shield plans have been offering more narrow network plans generally and on the ACA’s public exchanges, but “state network adequacy” rules for ACA-compliant plans don’t generally allow patients to see providers via telehealth.

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“We think telemedicine should count for the network adequacy (rules) under Obamacare,” Henry DePhillips, chief medical officer at telehealth vendor Teladoc, told journalists at the Association of Health Care Journalists annual meeting in Cleveland at the Global Center for Health Innovation.

But researchers from Georgetown University say states restrict access to telemedicine, saying certain patients need to see doctors in person and “face opposition from local clinicians who think telemedicine could replace them, or be used as leverage against them in negotiations over fees.”

To be sure, the health journalist meeting panel said state medical boards are powerful and hold sway over network adequacy rules. Though more health plans like Aetna, UnitedHealth Group and Cigna are offering more benefits to employers that include coverage of telehealth consultations, they are limited with the plans they offer on the exchanges.

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