On one of my recent travels, I read in the Brunswick News about the decision by Blue Cross Blue Shield of Georgia (BCBSGA), an Anthem affiliate, to no longer pay for non-urgent emergency room visits – see Health System CEO Speaks On Local Impact Of National Health Care Debate.
At first I was skeptical. How would a consumer know if their high fever or heart palpitations was an emergency? How would the new policy be applied?
But, after learning more about the policy (see our coverage in Blue Cross Blue Shield Of Georgia Enforces Policy Of No Reimbursement For Non-Urgent Emergency Department Visits ), the criteria seem pretty straightforward. These new rules were sent in late May to BCBSGA members, explaining the provisions of the policy and encouraging members with non-emergency conditions to seek treatment at an urgent care clinic, a retail clinic, a physician’s office, or via telemedicine. After thinking more about this change in benefits, I saw it as just another part of an evolution pushing consumers to use telehealth and retail clinics as a first-line urgent care triage tool (see A ‘Perfect Storm’ For Telemental Health).
We have seen health plans encourage their members to use telehealth. Good examples include Optum paying for telemental health the same as in-person visits (see For Health Plans, Technology = Improved Consumer Access) and Cigna’s expansion of its suite of telehealth behavioral and physical health services for Cigna members in 2017 (see Cigna Expands Telehealth Behavioral Health Services). And for good reason – a recent analysis of the Humana At Home care management service for its Medicare Advantage members (which is includes telephonic support) found that participants had 45% fewer hospitalizations than non-participants (see Humana At Home Service Reduces Hospital Admissions by 45%).
There are growing numbers of immediate-access retail clinics and urgent care clinics – and health plans have extended coverage to these new levels of care (see The Urgent Care Opportunity, Urgent Care Vs. ER?, Going Retail!, and Another Level In The Continuum – The Micro-Hospital). In addition, on the medical home, health home, and primary care front, more health plans are requiring the provision of on-demand access to consumers with urgent health care problems (see Primary Care Goes Virtual & On-Demand). Both changes in policy are designed to prevent unnecessary use of emergency rooms.
The numbers really tell the story behind these policy changes. The typical charge for a telemedicine visit is $40 (see 59% Of Large-Employer Health Plans Covered Telemedicine In 2016; Substantial Increase Over 2015), while the mean cost for all consumer visits was $66 for retail clinics, $106 for a doctor’s office visit, $103 for an urgent care center visit, and $358 for an emergency room visit (see Retail Clinics Provide Low-Cost, Quality Care).
With cost pressures continuing and more “immediately available” consumer options, expect to see more of these policies in the near future. And, for more on getting your own telehealth program up and running, join OPEN MINDS Senior Associate Matthew Chamberlain on November 7 at The 2017 OPEN MINDS Technology & Informatics Institute for his session, “Telehealth Best Practices: How To Build A Successful, Sustainable Program.”