Tag: Telehealth

CAQH Index Benchmarks & Time Spent on Administrative Work in Healthcare

The CAQH Index benchmarks adoption, volume, cost savings opportunities and spend for transactions along the administrative workflow. The following metrics help measure progress towards an automated workflow. By tracking progress, the industry can more easily identify barriers that may be delaying automation and administrative simplification and focus efforts on them.

2021 CAQH INDEX®

The CAQH Index benchmarks adoption, volume, cost savings opportunities and spend for transactions along the administrative workflow.

The CAQH Index benchmarks adoption, volume, cost savings opportunities and spend for transactions along the administrative workflow. The following metrics help measure progress towards an automated workflow. By tracking progress, the industry can more easily identify barriers that may be delaying automation and administrative simplification and focus efforts on them.

ADMINISTRATIVE WORKFLOW


While COVID-19 touched all healthcare professionals, the pandemic impacted the medical and dental administrative workflows differently.

The following touches on MEDICAL and DENTAL.

Utilization

Policies developed by federal and state entities to curb the spread of COVID-19 resulted in lower utilization for both industries as people delayed, or went without, medical care. In general, lower utilization led to lower transaction volumes. Smaller dental practices were hit particularly hard by lower utilization as many offices were forced to close for several months or close permanently.

Spend

Although electronic adoption and volume increased for both industries, the spend associated with conducting administrative transactions varied. While the dental industry saw a drop in spend, the medical industry experienced an increase in spend as it dealt with more complicated factors related to COVID-19

Automation

As remote work increased, many medical and dental staff became more reliant on the use of electronic transactions to conduct business. Staff no longer had access to resources used to conduct manual transactions. Because of this, both industries saw an increase in electronic adoption.

Telemedicine


For the medical industry, the loss in volume was counterbalanced by the increase in telemedicine. Telemedicine expanded access to care while reducing exposure to the virus for staff and patients. Health plans and providers worked together to understand and confirm new requirements and varying codes around telemedicine which often resulted in costly and timely phone calls and manual work. And while manual volume dropped, manual transactions became more expensive, increasing overall spend and the
cost savings opportunity.

While manual volume dropped, manual transactions became more expensive, increasing overall spend and the cost savings opportunity.

While manual volume dropped, manual transactions became more expensive, increasing overall spend and the cost savings opportunity.

VOLUME

Overall administrative transaction volume decreased during 2020. Both the
medical and dental industries experienced drops in utilization as COVID-19
impacted healthcare policies, regulations, resources and social behaviors.

SPEND

Despite the decrease in overall medical transaction volume and growth in electronic adoption, total annual medical spend increased (12%) as manual transactions required more intensive intervention from providers to ensure that newly implemented requirements and codes were executed correctly and that patient medical records were current and accurate. Conversely, dental spending decreased due to lower utilization often resulting in office closures.

TIME (WASTED!)

Time Savings Opportunity — The time that providers could save by switching the remaining partially electronic and fully manual time to conduct a transaction to a fully electronic time.

Average Cost and Savings Opportunity per Transaction by Mode, Dental, 2021 CAQH Index

2021-caqh-indexDownload

Health Insurance Providers’ Actions Concerning Mental Health

  • AllWays Health Partners has teamed up with Lyra Health to offer a new solution to expand the availability of mental health support and counseling. Through Lyra, members will be able to seek clinically proven mental health support, find high-quality providers tailored to their individual needs, and book appointments quickly with a therapist or coach by video or in-person securely and confidentially. Lyra will be rolled out in phases beginning June 2022.
  • AmeriHealth Caritas posted 5 questions that patients can use to find culturally competent mental health professionals. The questions include:
    • Does the provider ask about your problems in the context of your social network, such as family or friends, others in your community?
    • Does the provider ask you what you think the causes of your problems are?
    • Does the provider ask about the most important aspects of your background or identity and whether they make a difference to your problem (i.e. discrimination)?
    • Does the provider ask about barriers that have prevented you from getting the help you need, including any stigmas or social determinants of health?
    • If there are differences in your backgrounds, does the provider ask about your concerns around these differences and what your expectations are?
  • A 3-year grant provided by the Anthem Blue Cross and Blue Shield Foundation to the Chris Atwood Foundation will allow more individuals to seamlessly progress from treatment for substance use disorder, incarceration, or other high-risk transition points into a safe and supportive recovery housing environment. For the past 9 years, the Foundation has worked to save lives from overdose and support recovery from substance use disorder. The $150,000 Anthem grant will support the organization’s Revive to Thrive program and allow them to offer housing and peer support to 300 more individuals.
  • The Anthem Foundation has committed $13 million in grants to promote equity in mental health, particularly for people with substance use disorders. Each program will focus on one of the following goals: prevention and early intervention of risk factors that lead to substance use disorders, improved access and quality of treatment to reduce morbidity and mortality of substance use disorders, and community support to promote lifelong recovery. These grants are part of up to $30 million the Foundation plans to invest over the next 3 years to make significant progress toward reducing substance use disorders and their health impacts.
  • Anthem Blue Cross and Blue Shield, through its Student Advantage health plans, has entered into an exclusive partnership with Christie Campus Health to help colleges and universities address escalating rates of anxiety and depression reported on campuses throughout the country. The 2 companies will provide a student-centered mental health platform that helps counseling centers meet the high demand for services. Christie Campus Health currently helps over 40 colleges and universities bring timely and accessible mental health and wellbeing support to more than 430,000 students. Christie Campus Health’s CONNECT@College product will allow Anthem Student Advantage to offer a comprehensive solution that focuses on both the physical and emotional wellbeing of today’s college student.
  • Anthem has launched a number of specific physical and mental health/substance use disorder (MH/SUD) health integrated care management and outreach programs utilizing predictive modeling related to comorbid conditions that include licensed clinicians and peer/wellness and recovery coaches. These programs include Cardiac Pain, Sleep Apnea, Predictive High Utilizing Alcohol and Opioid Users, and Suicide Prevention. Additionally, to meet the needs of members with complex conditions, Anthem created the High Outreach to Promote Engagement (HOPE) program. These populations have the highest rates of multiple chronic conditions and higher than average emergency room visits and inpatient admissions for both MH/SUD and physical health. Case managers in this program take a broad view of a patient’s whole health and assist consumers in a variety of ways, including providing transportation or coordinating doctor appointments. Anticipating and supporting member’s needs before and after they need medical care significantly improve member outcomes and lower healthcare costs. By anticipating and supporting members’ needs, Anthem has decreased major incidents such as ER visits and inpatient hospitalizations by 50%.
  • To respond to growing needs throughout its 72,000-square-mile footprint, Avera Health Plans opened a new four-story wing as part of its Avera Behavioral Health Hospital in Sioux Falls.The Helmsley Behavioral Health Center adds 60,000 more square feet of space for treating psychiatric needs among children, youth, and adults. This wing adds several new services including 24/7 Behavioral Health Urgent Care, observation care, youth addiction care services, and partial hospitalization for youth.The wing also will house Avera’s senior behavioral health unit, which is currently located on the Avera Prince of Peace campus. This will provide an opportunity to add to the continuity of mental health services while enhancing and expanding this program. In total, Avera Behavioral Health Hospital will have 146 inpatient behavioral health beds plus 8 addiction residential beds for adolescents – all private rooms.
  • Beacon Health Options has partnered with the Kennedy-Satcher Center for Mental Health Equity (KSCMHE) to address behavioral health equity ahead of the 988 suicide prevention lifeline launch in July. The partnership centers on 2 main components: a research and policy initiative that imagines equitable crisis response for the future of behavioral health service delivery, and a leadership summit to explore how to embed equity into crisis response. Some recommendations for embedding behavioral health equity into state and local 988 systems include:• Prioritizing visibility of groups that are historically excluded or inadequately reached by psychiatric emergency systems
    • Deploying law enforcement in psychiatric emergency response only as needed
    • Leveraging mobile crisis units staffed by culturally competent staffBeacon Health Options is a wholly-owned subsidiary of Anthem.
  • Blue Shield of California posted a back-to-school mental health Q&A with Dr. Nicole Stelter, Blue Shield’s Director of Behavioral Health. Dr. Stelter discussed the growing mental health crisis adolescents are facing, as well as steps students, parents, and teachers can take to support youth mental health.
  • Blue Shield of California is investing in 4 organizations that are working to support youth mental health in California. In total, Blue Shield of California is providing more than $1.1 million to the 4 organizations. Mental illness is the number one reason children in the state are hospitalized, and half of all lifetime cases of mental illness begin by the age of 14. The support is part of Blue Shield of California’s BlueSky Initiative, which provides resources and support for youth, families, educators, and caregivers to promote emotional well-being for youth. Over the last year, BlueSky and its programs almost doubled the number of educators it trained to spot warning signs of mental health concerns in youth, conducted more than 4,000 counseling sessions, and supported cultivating a pipeline of diverse youth to work in the mental health field. The new financial support will continue enhancing these mental health supports with a focus on reducing health disparities.
  • A recent Blue Shield of California post shared important points for seniors about behavioral health, mental health stigma, the pandemic’s effect on this health issue, and how treatment and self-care can help. Getting treatment sooner rather than later is important, and seniors should start by making an appointment to see a primary care doctor or a mental health care professional to discuss whether treatment might help, said Jennifer Christian Herman, vice president, Mindbody Medicine at Blue Shield of California.
  • Funding from Blue Shield of California’s BlueSky youth mental health initiative has let the National Alliance on Mental Health (NAMI) California expand its On Campus High School clubs throughout the state, increasing membership from 1,051 in 2020 to 1,271 participants in 80 clubs across 16 counties in 2022. The clubs provide peer-led support for students with mental health conditions, students whose family members have a condition, or students who are interested in the field or in advocacy – all focused on the goal of reducing mental health stigma among youth.
  • The Health Care Service Corporation is providing access to an online self-service platform to help fill a gap for some untreated members who have been reluctant to seek care or had difficulty finding it. The platform, provided by an independent company called Learn to Live, offers around-the-clock mental health assessments and online cognitive behavioral therapy (CBT) for mild to moderate depression, substance use, social anxiety, insomnia, and stress, worry, and anxiety. It is available at no added cost to 11 million members, starting at 13 years of age, in most group health plans across its communities in Illinois, Montana, New Mexico, Oklahoma, and Texas.
  • Blue Cross and Blue Shield of Montana awarded 4 nonprofits with a $70,000 Big Blue Sky Initiative major grant through the Healthy Kids, Healthy Families® program. All 4 grant recipients will use the funds to help improve pediatric behavioral health. In addition to the 4 grants, Blue Cross and Blue Shield of Montana also made a $15,000 grant to NAMI Montana to bolster the organization’s mission to support, educate, and advocate for Montanans with mental illnesses and their families.
  • Blue Cross and Blue Shield of Montana (BCBSMT) is providing access to an online self-service platform to help fill a gap for some untreated members who have been reluctant to seek care or had difficulty finding it. The platform, provided by an independent company called Learn to Live, offers around-the-clock mental health assessments and online cognitive behavioral therapy (CBT) for mild to moderate depression, substance use, social anxiety, insomnia, and stress, worry and anxiety. It will be available at no added cost to members at least 13 years old in most of group health plans.
  • Blue Cross and Blue Shield of Montana is becoming more strategic in coordinating access to life-saving behavioral health services for members throughout the state — particularly in its most isolated areas. BCBSMT launched Big Blue Sky Initiative in 2018 to help fight opioid abuse, rising suicide rates, and methamphetamine and heroin epidemics. The company also helped fund a new psychiatry residency to bring more mental health professionals to Montana, as well as other programs. To improve access, leaders are working with providers and policymakers to develop care models that will keep members closer to home and reduce obstacles to care, including expanded telehealth services. The effort is part of a larger initiative to create more medical and behavioral health access and better care management for BCBSMT members no matter where they live.
  • New Mexico Kids Matter received a $25,000 grant from Blue Cross and Blue Shield of New Mexico’s Healthy Kids, Healthy Families® initiative. The grant will support New Mexico Kids Matter’s Successful Transitions and Adulthood Readiness (STAR) Program, which works to prepare teen foster youth for their transition out of foster care and into healthy and safe adulthood and independent living situations. Studies have shown youth who spent their teenage years in foster care and/or aged out of the foster care system suffered significant challenges as adults in the areas of mental health, education, employment, and finances. Without intervention, these youth have a higher likelihood of violence, homelessness, incarceration, and poverty in their adult lives.
  • Jardin de los Niños has received a $25,000 grant from Blue Cross and Blue Shield of New Mexico’s Healthy Kids, Healthy Families® initiative. The grant supports Jardin de los Niños’ Flourishing Families Infant Mental Health and Wellness Program, which provides direct therapy services to homeless and near-homeless children and their families to address trauma. The grant also supports an anti-hunger component that provides healthy and nutritious meals to address food insecurity.
  • Blue Cross and Blue Shield of North Carolina is expanding its network of behavioral health providers through a collaboration with Headway, a mental health care company that works with insurers to deliver high-value mental health care. Together the 2 companies will make it easier for Blue Cross NC members to quickly access – as soon as 48 hours – in-network therapists and psychiatrists who meet their specific needs. The focus of the collaboration is on improving access to care for underserved communities, including rural and socially vulnerable counties, children and adolescents, and individuals across diverse racial and ethnic backgrounds.
  • Blue Cross and Blue Shield of North Carolina is investing more than $2 million to support 11 organizations across North Carolina to improve access to behavioral health care services in rural and marginalized communities and in HPSAs (Health Professional Shortage Areas). This funding initiative is part of Blue Cross NC’s statewide commitment aimed at addressing and eliminating racial, health, and geographical disparities in North Carolina and supports the company’s goal to improve access to behavioral health care in rural and underserved communities by 25% in 5 years.
  • Blue Cross and Blue Shield of North Carolina has announced a new collaboration with Mindoula to help address the complex health needs of members with serious mental illness and/or substance use disorder. The program leverages expertise from the tech-enabled behavioral health management company to expand access to behavioral health services and will launch on January 1, 2023. Blue Cross NC will work with Mindoula to directly address the mental health crisis and health care shortage in North Carolina by providing tech-enabled support that expands outpatient behavioral health care to members in the greater Triangle area, as well as eligible members outside of North Carolina.
  • Blue Cross and Blue Shield of Oklahoma has made a grant to the National Alliance on Mental Illness of Oklahoma to support mental health efforts focused on young children. The grant will support the “Meet Little Monster” coloring and mental health activity book created for young children to express and explore their feelings as well as to help foster dialogue between children and the safe adults in their lives. The book is available in English and Spanish for families, organizations, teachers, and young people across Oklahoma at no cost.
  • The CalOptima Board of Directors has authorized a grant agreement of up to $1 million to support the Be Well Orange Campus, a mental health and substance use treatment facility in Orange. The grant will enhance intake and admissions coordination services for CalOptima Medi-Cal members who need behavioral health services. The two-year grant will ensure CalOptima members have timely access to services, assessment and placement into care through an improved intake and coordination process at the Be Well Orange Campus. The cost of coordination includes staffing, training and development, administrative services, and a phone system upgrade.
  • The Cambia Health Foundation has invested more than $300,000 in non-profit organizations that are part of the National Suicide Prevention Lifeline system. The goal of the investments is to support, expand, diversify, and train the behavioral health workforce.
  • CareFirst BlueCross BlueShield is collaborating with Headway, a tech-enabled company that expands access to in-network mental health care by removing barriers faced by providers, payers, and the people they serve, to support CareFirst’s mental healthcare system. The collaboration will help eliminate obstacles to providing and accessing behavioral health while delivering quality, easy-to-access mental health care for all members. Headway’s secure online platform is available to CareFirst’s network of mental health providers at no cost and will enable efficient scheduling, billing and more. This allows providers to focus on quality care delivery, rather than administrative tasks.
  • CareOregon has provided Lutheran Community Services Northwest with a $79,867 grant to help make more culturally specific mental health resources available to newly arriving and already resettled Ukrainian refugees in the region. The funds from the grant will be used to hire 1 additional full-time peer support specialist and 1 Ukrainian speaking clinician that will support the increasing demand for care. The grant will also help fund additional support for the broader Ukrainian community. The peer support specialist will provide timely support to Ukrainian refugees to help address mental health and trauma and connect clients to the appropriate services and resources. Services include individualized psychological first aid such as mental health counseling, emotional support groups, workshops to aid in resettlement and referrals for any additional needs like wellness exams, immunizations, housing, employment and more.
  • CareOregon announced that it has awarded $210,000 in community giving grants to nine local nonprofit organizations that provide social support and improve access to medical care for seniors, communities of color and other underrepresented communities across the Portland metropolitan region. Among the grants awarded, CareOregon is investing $50,000 in Lines for Life’s Cultural Engagement Initiative, which prioritizes the mental health needs of communities of color. The funding will support Lines for Life’s effort to reach 1,500 community members who identify as Black, Indigenous, and from other communities of color with mental health support through direct outreach by community health workers and hosting community-wide events that aim to reduce stigma.
  • CareOregon and the Alliance for Culturally Specific Behavioral Health Providers have codesigned a payment model to improve health outcomes for Oregon’s communities of color. Numerous national studies have shown that these communities are disproportionately impacted by lack of access to mental health support. Over the past 2 years, the collaboration has hit several milestones, most recently resulting in expanded payments for culturally specific providers that leverages both traditional payment models by increasing rates and Health Related Service dollars to compensate providers for time invested in outreach and engagement activities. These changes will result in an increase of up to 20% in payment to culturally specific providers.
  • CareSource is collaborating with Clarigent Health to bring artificial intelligence to behavioral health providers in Ohio. Clairity, Clarigent Health’s software tool, analyzes speech with artificial intelligence trained to identify patients at risk of suicide. Behavioral health providers in the Ohio Children’s Alliance (OCA) and Ohio Behavioral Health Provider Network (OBHPN) can now be reimbursed through CareSource when using Clairity. Between the 2 networks, more than 265,000 families and youth will have access to the technology.
  • The CareSource Foundation has awarded Overdose Lifeline, Inc. a more than $178,000 grant to improve the prevention of and response to opioid overdoses in Indiana schools. These funds will provide school partners with the emergency, life-saving medication naloxone, develop a custom training course for school staff and connect schools to evidence-based prevention programs.
  • CareSource has announced a new option with the Montgomery County Board of Developmental Disabilities (MCBDDS) and I Am Boundless to provide respite care for parents and other caregivers of people with intellectual and developmental disabilities (I/DD) and behavioral health challenges. This new collaboration will provide respite services to those families with I/DD youth. Services such as after-school and day programming, and therapeutic supports will be embedded in each respite opportunity.
  • Centene has launched an all-employee training on Mental Health and Substance Use Disorder Parity to educate employees on parity law and outline Centene’s policies that ensure delivery of benefits that do not discriminate against individuals with mental health conditions or substance use disorders. Centene also maintains youth and adolescent programs focused on mental health, including the Choose Tomorrow™ Suicide Prevention Program, which uses evidence-based practices to screen for suicide risk, develop member-driven safety planning, provide connection to community resources, and monitor members’ treatment progress to prevent suicide.
  • Centene is a driving partner in solving the problem of social isolation in schools through No One Eats Alone® Day, created by the nonprofit Beyond Differences and sponsored by The Centene Charitable Foundation. Mental well-being is especially important now as youth continue to experience stressors from the COVID-19 pandemic. Centene health plans across the country helped raise awareness by hosting virtual and in-person events in February and March to encourage inclusion and teach children how to combat isolation. They worked with 108 schools across 10 states, engaging at least 48,500 students in educational and fun activities.
  • Centene recently released a white paper entitled, “Advocating for the Mental Health of Medicare Recipients.” The white paper notes the important role Medicare plays in the more than 63 million Americans who received Medicare benefits in 2021 and the unique challenges the Medicare population faces.The white paper also highlight’s Centene’s role in keeping people enrolled in Medicare healthy, stating: “While recent policy changes have improved access to mental health services for Medicare beneficiaries, there is still work to be done to ensure they can easily receive the care they need to live healthier, higher-quality lives. As an industry leader and one of the largest Managed Care Organizations in the country serving many of our nation’s most vulnerable citizens, Centene is committed to ensuring the mental wellbeing of Medicare beneficiaries through access to high-quality care, innovative programs, and a wide range of health solutions.”
  • The Cigna Foundation has made more than $3 million in grants to local nonprofits to help address childhood hunger and mental health concerns as schools return to session. Programs spanning communities in 16 states will receive critical financial support enabling them to positively impact thousands of children across the country. All grants are made available through Cigna Foundation’s Healthier Kids For Our Future® program, a 5-year, $25 million global initiative focused on improving the health and well-being of children. Since its inception in 2019, the program has awarded more than $18 million in grants.
  • Cigna Chairman and CEO David M. Cordani unveiled new findings about the growing mental health crisis among teenagers and the impact it is having on parents, both at home and work. Cigna and Evernorth, its health services business, commissioned the study from Economist Impact to examine the mental health effects of the COVID-19 pandemic on teenagers and their parents. The study was conducted in April 2022 and key findings include:
    • Approximately 80% of working parents reported some form of impact on the mental health of their teenage children as a result of the pandemic, including new or increased levels of anxiety, depression, behavioral issues, and problems with social interactions.
    • Nearly one in five working parents reported a negative impact on their work performance and productivity because of concerns about their child’s mental health.
  • Aetna, a CVS health company, and Psych Hub have launched an Adolescent Treatment Training Series to meet the urgent needs of youth and young adults. This joint effort arms the 283,000 behavioral health and employee assistance program providers in Aetna’s commercial network, Aetna’s internal clinicians, and CVS Health’s licensed counselors at MinuteClinics in select HealthHUB locations with access to a no-cost, evidence-based curriculum in the form of courses and resources to identify and treat adolescents and young adults along a full continuum of care, from prevention through intervention, for those at risk of suicide.
  • CVS Health is providing support to the National Association of Free and Charitable Clinics, the American Foundation for Suicide Prevention, and Mental Health America, in recognition of Mental Health Awareness Month. The support is focused on equitable, quality access to mental health care services and resources, particularly among the Black, Indigenous, and People of Color (BIPOC) community. A recent CVS Health/Morning Consult survey of Americans age 18+ also found that mental health concerns are continuing to rise among individuals of all backgrounds, especially Black, age 65+, young adult, and LGBTQIA+ respondents. The survey also found more Americans agree that the pandemic has made them more comfortable seeking support for mental health and using technology to address it.
  • Elevance Health is working to address the behavioral and mental health care needs of all members, at every age. Through the Sydney Health app, for example, a spectrum of care delivery options is available: digital, virtual, and in-person. Sydney Health can connect eligible members to a virtual text visit or a video visit with a behavioral or mental health provider such as a therapist or counselor. The app allows users to get important information about benefits and claims, track progress toward health goals, access a member ID card, and more. Elevance Health is also dedicated to advancing health equity through a “health equity by design” approach. This approach is personalized and intentional, ensuring that people can receive individualized care.
  • The Florida Blue Foundation is making a $3.8 million investment to enhance mental health for Florida’s children, families, and seniors. Twelve nonprofit organizations across the state share in the investment, which will support community-based programs that directly improve access to and quality of mental well-being services, particularly for the underserved and uninsured, including racial and ethnic minorities, and low-income populations. The investment will provide mental health counseling and education in schools for under/uninsured students and provide a safe environment for mental and emotional healing for members of the LGBTQ+ community, transgender individuals, victims of hate crimes, and LGBTQ+ seniors, in addition to supporting other mental health programs.
  • Highmark is encouraging members to focus on mental health in 2022 and is reminding them of resources that are available to better manage stress, anxiety, and depression. One new option for members is Meru Health, a 12-week evidence-based program to treat depression, anxiety, and burnout that mixes a clinical human touch with technology, self-care, and data via a discreet smartphone app. The 12-week treatment program includes consultation with a dedicated licensed therapist, evidence-based video lessons, guided mindfulness practices, habit-changing activities, and anonymous peer support groups, all done on a mobile device. Members will also have access to on-going support following the completion of the 12-week program.
  • Horizon Blue Cross Blue Shield of New Jersey members have access to Equip as an in-network option. Equip offers Family-Based Treatment for eating disorders through a 5-person virtual care team including a therapist, dietitian, medical provider, peer mentor, and family mentor. Equip is designed to replace the residential level of care and support families throughout their journey to really be the last treatment they will need.
  • Horizon Blue Cross and Blue Shield of New Jersey is offering eligible members access to MindRight Health, a mental health coaching service that leverages texting to provide coaching and emotional support to young adults ages 13 to 25. Once users sign up on their phones (no face-to-face meeting or phone call required), they can receive guidance from a team of coaches supervised by licensed mental health clinicians.
  • Independence Blue Cross released a video featuring Independence and community experts discussing how the COVID-19 pandemic has changed the ways in which people think about mental health and access behavioral health services. The video discussed changes in the workplace, the increased use of telemedicine, persistent disparities in health care, and how Independence can support young people who have suffered losses during this time.
  • Independent Health highlighted the mental and physical health benefits of yoga at the 2nd annual Yogathon for Suicide Awareness & Prevention, presented in conjunction with Power Yoga Buffalo. The Yogathon helped raise awareness of suicide prevention as well as funds to benefit mental health programs at Mental Health Advocates of WNY.
  • Independent Health has been awarded the 2022 platinum Bell Seal for Workplace Mental Health by Mental Health America (MHA). The Bell Seal is a workplace mental health certification that recognizes employers who strive to create mentally healthy workplaces for their employees. Independent Health is the only organization in Western New York to be certified by MHA. Independent Health’s status as a platinum-level Bell Seal-certified organization demonstrates the company’s ongoing commitment to employee mental health and well-being, which in turn is instilled in the company’s wellness and mental health programming for its employer groups and members.
  • Kaiser Permanente has awarded a 2-year, $125,000 grant to the Boulder Valley School District to bolster ongoing efforts to increase mental health among teachers, staff, students, and their families following the recent Marshall Fire. The grant will help the district expand an existing Kaiser Permanente initiative called Resilience in School Environments, or RISE. The program provides emotional support and trauma-informed training to staff members, who then help other staff members and students. The grant will extend support for staff members, students, and families who are experiencing traumatic stress following the Marshall Fire.
  • A mental health initiative developed by Kaiser Permanente and esports organization Cloud9 has been found to be an effective way of supporting the mental health of young adult esports players and fans, according to a new study from the NEJM Catalyst. Presence of Mind launched in May 2020 with the goal of reaching teens and young adults with positive mental health messages in places where they spend a lot of their time: online gaming and esports platforms. The initiative includes 2 seasons of live Twitch Stream series featuring prominent players; mental health experts and influencers; creator-led YouTube video content from some of esports’ favorite players sharing insights, positivity, and personal mental health messages; and a series of free, online interactive training sessions to help address critical mental health issues. As of May 2022, the training sessions have been accessed by more than 51,000 teens and young adult gamers who have learned how to better manage their mental health and support their friends when they need it most.
  • A telehealth program at Kaiser Permanente Northern California (KPNC) is expanding support for people with serious, persistent mental illness by adding psychiatric clinical pharmacists to their care teams. The care teams deliver a package of comprehensive care for a highly vulnerable patient population, who are more likely to have chronic conditions such as diabetes and hypertension and a lifespan shortened by 10 to 25 years. The program takes advantage of a growing workforce of clinical pharmacists with 2 years of postgraduate training in psychiatry. Working closely as a team with the patient’s psychiatrist and other clinicians, clinical pharmacists act as care navigators, establishing an ongoing partnership with patients through regular video and telephone appointments.
  • Kaiser Permanente adult members in Colorado now have access to a 90-day subscription to Ginger, an on-demand mental health care solutions provider. Ginger provides confidential emotional support through on-demand coaching via text-based chats and skills-building content. Eligible members can use their smartphone to connect with a highly trained emotional support coach 24/7 — at no cost and with no referral or appointment needed. The private, one-on-one texting sessions provide support in coping with common challenges such as managing stress or getting better sleep.
  • Kaiser Permanente in Hawaii has awarded a $500,000 grant to Mental Health America of Hawaii to support its youth resilience and wellness training and education program. The program will provide 1,300 youth and youth-serving adults with evidence-informed suicide prevention and bullying prevention training over 6 months and will enable Mental Health America of Hawaii to increase training to individuals in rural areas of Oahu, Hawaii Island, and Kauai.
  • Magellan Healthcare will hold a series of virtual events in support of Suicide Prevention Awareness Month and Recovery Month in September. Magellan will host events Sept. 14 and 22 focused on suicide prevention, and recovery from mental health and substance use conditions.
  • Magellan Health, Inc. has opened a complimentary 24-hour crisis line for individuals impacted by gun violence in Chicago and surrounding communities. Magellan confidential consultation services are offered at no charge to the communities to assist individuals as they work to cope with the feelings of fear, sadness, anger, or hopelessness related to these kinds of incidents. Crisis line callers may also seek information and guidance to other available resources, such as community-based support.
  • Magellan Health subsidiary Magellan Federal has launched a program that provides United States military families with personalized, digital mental health and well-being support by combining NeuroFlow’s technology with evidence-based resources and clinical support provided by Magellan Healthcare. The 18-month long first phase will be launched on three installations through the Military & Family Life Counseling (MFLC) program. NeuroFlow will supplement Magellan’s MFLC counseling services to provide service members and their spouses with personalized, self-directed mental health resources, tools, and support, all from a smartphone. Member usage of NeuroFlow will also produce de-identified, population-level data to highlight mental health trends at each installation without compromising an individual service member’s privacy.
  • Magellan Health has opened a complimentary 24-hour crisis line for individuals impacted by the elementary school shooting that occurred in Uvalde, Texas. The line is available to all Superior HealthPlan members and the local community. The toll-free number to access free, confidential consultation services is 1-800-327-7451. Magellan confidential consultation services are offered at no charge to the community to assist individuals as they work to cope with the feelings of fear, sadness, anger, or hopelessness related to these kinds of incidents.
  • Magellan Healthcare has launched a Digital Emotional Wellbeing program that helps members improve overall health and wellbeing, manage stress, and build resilience in a confidential manner. Participating Magellan members with emotional concerns who use the NeuroFlow app or website receive recommendations and have access to activities to help them improve their overall health. Activities include evidence-based videos, articles, and behavioral trackers, as well as Magellan’s digital cognitive behavioral therapy programs, FearFighter® for anxiety and MoodCalmer® for depression. These activities will provide members with personalized, self-directed behavioral health resources, tools, and support, all from the secure, anonymous convenience of NeuroFlow’s app and website.
  • Magellan Healthcare is offering resources to support the emotional wellness of first responders, health care workers, and the National Guard in Idaho who are serving on the front lines of the coronavirus pandemic. Magellan continues to make available a free, confidential 24-hour crisis line. This is available for all first responders, health care workers, and the Idaho National Guard citizen soldiers and airmen. Critical care workers coping with feelings of fear, sadness, anger and hopelessness can call the toll free 1-800-327-7451 (TTY 711) to speak directly with a licensed mental health clinician and receive information on community-based support.
  • Magellan Health launched eMbrace, an industry-first total wellbeing solution for employers with more than 500 employees, on April 1, 2022. The solution aims to help people move from suffering and struggling in their everyday life to thriving. eMbrace is built to address multiple areas of an individual’s life, proactively assessing if they are thriving, struggling, or suffering across six essential elements: career, social, financial, physical, community, and emotional. eMbrace also includes a special version of the Gallup® WellbeingFinder™ that offers employees a personalized wellbeing plan addressing all six elements. Employees are directed to services and resources that address their pressing needs first, from legal, financial, and identity theft services to digital cognitive behavioral therapy modules, coaching, and counseling.
  • Martin’s Point Health Care has released an update focused on helping men make mental health a priority. The update covers several steps men can take, including connecting with others, taking care of yourself, and talking to your doctor. Mental health struggles are linked to the increase in deaths related to alcohol and drugs, and 1 in 4 adults with mental health disorders also struggle with substance abuse.
  • Medica has introduced 2 new support programs to help simplify the mental health care experience and connect children and their families to the support they need. The Family Support Program provides clinical expertise and care navigation support to caregivers of children with complex mental health needs, while the Family Support Navigator is an interactive online tool that helps parents and caregivers find the right resources for children who may have autism or depression. Both programs are available to Medica members who have children with complex mental health needs.
  • MHS Indiana highlighted the mental health supports available to members, including access to MyStrength, a free resource that includes tools to hep reduce stress, anxiety, depression, and substance abuse. MHS also maintains a 24-hour crisis text line, where members can speak with trained crisis counselors, and offers members access to Teladoc for non-emergency issues.
  • Molina Healthcare of New Mexico has partnered with Pyx Health to expand access to behavioral health services for Molina’s Medicare members. Through a screening process, working with members and data, the Pyx Health platform gauges the emotional state of users. This data is then monitored by support staff that provides actionable recommendations for how to respond, such as calling a user to address their behavioral health needs or offering support during a rough time. By providing access to this platform, Molina will improve behavioral health outcomes for its members.
  • Molina Healthcare of California has partnered with WEconnect Health Management, giving Molina’s network providers access to the WEconnect Recovery mobile platform to support Molina members dealing with substance misuse and mental health challenges. The app provides a supportive environment to Molina’s Medi-Cal members engaged in the recovery process by delivering critical resources to their phones. WEconnect facilitates daily reminders, medical appointment alerts, and rewards milestones with incentives in the form of gift cards for CVS, Safeway, and Amazon, among others. Members also have access to mobile recovery meetings throughout the day and exclusive Molina-enabled peer recovery support services for on-demand, one-on-one support.
  • Molina Healthcare of California has partnered with BeMe Health, a digital behavioral health company, to provide Molina Medi-Cal members, ages 13 to 19, with access to digital tools, content, and support designed to tackle some of the most prevalent mental and social challenges facing today’s teens. The offering will provide young Molina members with activities, one-on-one coaching and more through an interactive mobile app designed to help teens feel acknowledged and empowered. The app features digital tools and interventions to teach teens coping skills, provide support for issues they may be facing, and offer engaging content that can help take the focus off daily struggles and challenges. In addition, teen members will have access to clinical services, with parental consent, and crisis support.
  • The MolinaCares Accord, in collaboration with Molina Healthcare of Washington, recently committed $400,000 to the University of Washington School of Nursing to help expand the behavioral health workforce in the state through the development and implementation of a blended family and psychiatric primary care curriculum for nurse practitioners.
  • The MolinaCares Accord, in collaboration with Molina Healthcare of Washington, has announced a $77,000 grant to SPARK, an organization dedicated to providing a career pathway for youth and students to become certified peer counselors in the state of Washington. The grant is just one component of MolinaCares’ Behavioral Health Initiative, an over $700,000 philanthropic effort to expand access to behavioral health care across Washington. The funds donated to SPARK will go toward the identification, outreach, training, and placement of youth peer supports in the state.
  • The Molina Healthcare Charitable Foundation, in conjunction with Molina Healthcare of Florida and in partnership with the Federation of Families of Central Florida, recently welcomed families to the MolinaCares Youth Festival. The event focused on supporting the growing number of young people and families affected by mental illness. This year, through a $15,000 grant from the Foundation, the Federation of Families of Central Florida is hosting monthly group meeting for teens and young adults centered on improving mental health. In those meetings, participants engage in activities and listen to speakers, while being encouraged to find creative outlets as part of the healing process.
  • The MolinaCares Accord, in collaboration with Molina Healthcare of Washington, has presented a $100,000 grant to support Compass Health’s Broadway Campus Redevelopment Project. The grant will help fund construction of a 72,000 square-foot facility that will expand community-based behavioral health care services and its workforce in northwest Washington. The grant is a part of The MolinaCares Behavioral Health Initiative to increase access to behavioral health across the state.
  • Eleanor Health, an outpatient addiction and mental health provider is collaborating with Point32Health on a program to support Tufts Health Plan MassHealth members with substance use disorders and other mental and physical health comorbidities. The value-based program uses a population health management model and provides patients with comprehensive care including access to medications for substance use disorder, psychiatry and mental health care, group and individual therapy, nurse care management and peer support.
  • Members of Regence Health Plans have access to a wide range of behavioral health care, from traditional in-person therapy to specialized virtual care. To improve access to care, Regence added more than 1,500 new behavioral health providers to its network in 2022. To support members in rural areas with little access to care, Regence has added virtual care providers available nationwide who specialize in everything from substance use disorder to individual therapy to child and family therapy, obsessive-compulsive disorder and more. Regence’s dedicated behavioral health team continually evaluates and contracts with virtual care providers that would add unique value to its array of resources for members seeking support. Regence is continuing an $11.5 million multi-year philanthropic initiative to increase access, improve quality of care, and reduce mental health stigma. Additionally, approximately $4 million of investments were made from its corporate foundation in 2021 to increase access to mental health support for people living in rural communities across Idaho, Oregon, Utah, and Washington.
  • Security Health Plan’s new partnership with Freespira, Inc., maker of the first FDA-cleared digital therapeutic treatment for panic attacks, panic disorder and post-traumatic stress disorder (PTSD), will provide many members with a clinical alternative to current treatments. Freespira works by addressing the underlying physiological factors behind panic attacks and post-traumatic stress disorder. As an adjunct to medications and counseling therapy, the treatment normalizes breathing irregularities developed in response to underlying carbon dioxide (CO2) hypersensitivity. The Freespira treatment provides users with real-time physiological feedback-based training to regulate their respiration rate and exhaled CO2 levels. Telehealth coaching guides patients throughout the 28-day care journey to deliver maximum benefits from the twice daily, 17-minute treatments.
  • Security Health Plan and Marshfield Medical Center-Rice Lake are investing in a mental health program from the Turtle Lake School District. School Pulse is an anonymous, interactive program that works to improve the mental health of students. The program provides social and emotional support to students through their cell phones and helps promote mental wellness and decrease suicide rates in young people. The School Pulse program uses texting to check in with students about their mental health 3 times a week, all year long. Students who wish to participate in the program will receive real-time help through open, anonymous communication through a platform that works just like texting.
  • Security Health Plan and Marshfield Clinic Health System are accepting applications from eligible school districts to implement b.e.s.t.® Universal Screening in the 2022-23 school year. b.e.s.t.® (Behavioral Emotional Social Traits) is an online screening tool designed to help education professionals build the emotional health of students and help identify students who may need additional positive behavioral support. The tool provides educators recommended actions to take with students based on their behaviors. Schools awarded a grant receive technical support, biannual screenings for students, and training consultation and support for teachers and staff.
  • Sharp Health Plan has released an update providing tips on finding the right mental health support. For example, there are many types of mental health professionals, including therapists and counselors, psychiatrists, and psychologists, all with distinct differences. Steps to take include thinking about your specific mental health needs, doing your research on what kind of mental health professional you’d like to see, and writing down question about things that are important to you before your appointment.
  • Sunflower Health Plan is partnering with the National Alliance on Mental Illness (NAMI) of Kansas to help increase access to educational resources for family members and supporters of those living with mental illness. Through the partnership, Sunflower will support NAMI’s Family-to-Family, a free, 8-session educational program for families, significant others, and friends of people with mental health conditions and Family Support Groups, peer-led support groups for adults with loved ones experiencing symptoms of a mental health condition. The groups allow family members to share their experiences and gain insight from the challenges and successes of others facing similar situations.
  • Sunshine Health recently sponsored the Volunteer Florida’s Healthy Minds Teen Summit, where roughly 75 Florida middle and high school student leaders gathered to talk about normalizing mental health as a critical self-care topic. Breaking the stigma was the number one topic for these teen leaders, who learned about strategies and resources to take back to their peers to help deal with everything from the stresses of everyday life, to dealing with severe trauma. Inspirational speakers helped motivate the teens and shared their stories about mental health. Former college basketball star turned business owner Iman MacFarland introduced three-time Olympic Gymnast Dominque Dawes.
  • Superior HealthPlan released a short video addressing mental illness and what Superior employees need to know about it. The video featured Dr. Sandy Vale, Superior’s lead behavioral health medical director, who talked about what mental illness is, warning signs, and potential treatments.
  • Sutter Health Plus members have premium access to Sanvello at no extra cost as part of their behavioral health care benefits through U.S. Behavioral Health Plan, California. Sanvello is an app that offers on-demand clinically proven techniques to manage symptoms of stress, anxiety, and depression as they happen. By answering a few questions in the Sanvello app throughout the week to assess mood and track activities like caffeine intake, sleep, and exercise, members can identify patterns in their behavior to make positive lifestyle changes. They can also create progress assessments using past mood and health ratings to discover new connections between their experiences and emotions.
  • Leaders at UCare and Kente Circle are seeking make it okay to discuss mental health issues with trusted barbers and stylists. The Confess Project – America’s First Mental Health Barbershop Movement – empowers frontline heroes to support their clients’ mental health and substance use disorder needs. The barbershop or hair salon is often a safe place for clients to discuss their concerns and needs. Armed with the Confess Project training, barbers and stylists will be able to say: “I am more than a pair of clippers. I am improving my community through the barber chair one client at a time.”
  • UCare and mental health providers Alluma and the Amherst H. Wilder Foundation have developed a pilot program to make it easier for prospective mental health professionals to join the field. Through the partnership, UCare will fund $100,000 in stipends for clinical interns as they complete the supervision necessary to graduate from and eventually be licensed in social work, clinical counseling, marriage and family therapy, and other mental health roles. Wilder and Alluma will provide thousands of hours of state mandated supervision at no cost. The pilot will focus on supporting clinical interns from cultural and ethnic minority groups, rural communities, and other underrepresented populations where the workforce needs are greatest.
  • UPMC Health Plan’s Special Needs Plan Severely Mentally Ill team provides community-based care management services to members with a serious mental illness diagnosis. The team services those with the highest needs of physical health and behavioral health indicators as identified by physical, behavioral and pharmacy claims utilization data in a rolling 12-month period. Goals of the program include: care integration for member physical health and behavioral health conditions, development of self-management skills and improved quality of life. Outcomes include improved HEDIS measures, as well as reductions in Emergency Department visits and inpatient admissions. UPMC’s Community Care Behavioral Health Organization, part of the UPMC Insurances Division, is also working with stylists and barbers to develop an innovative community engagement initiative known as Health Access Initiative for Recovery (Our HAIR). This initiative centers on partnering with barbers and stylists in Pittsburgh to build up black and brown communities through increasing familiarity with, comfort around and connection to resources related to behavioral health concerns seen within hair care settings. In the Our Hair initiative, hair stylists/barbers will have an opportunity to participate in a program that teaches them how to talk about and provide resources for mental health and drug/alcohol/substance use concerns within their communities. The goal is to increase engagement, education, and resource dissemination about behavioral health issues within historically underserved communities and to decrease the behavioral health care disparities between Black and White members.
  • UPMC Health Plan provides support to parents as they build resilience with their children to cope with the stresses of the pandemic and beyond. Teaching children the cognitive mental health techniques they need to excel will enhance their strength to overcome common psychological responses (such as insomnia or fear), health risk behaviors, and mental health conditions like depression and anxiety. UPMC providers continue to offer in-person and virtual appointments for members and UPMC Health Plan has several additional resources to assist in addressing children, youth, and parent/guardian behavioral health needs. RxWell, for example, is UPMC Health Plan’s evidence-based mobile app for ages 16 and older to help members become emotionally and physically healthy by building better lifestyle habits. The app combines health coaching support with provider-endorsed techniques, including self-guided exercises and other tools to help members manage stress, anxiety, and depression and reach their health-related goals. Currently there are 7 programs to choose from based on a member’s needs: Depression, Anxiety, Stress, Weight Management, Nutrition, Physical Activity, and Ready to Quit (tobacco cessation).
  • A team of investigators from UPMC Children’s Hospital of Pittsburgh found that a digital application may remove barriers to mental health care and is associated with reduced emotional distress when offered as part of routine pediatric care. The findings were published in Psychiatric Services. UPMC initially studied RxWell™, a digital application developed by UPMC Health Plan to support its members with management of depression and other health and wellness challenges and published positive outcomes in adult users.

Thoughts from Alex Yarijanian and Carenodes outcomes

Healthcare Startups take too long to go to market hence innovations do not get to the American people in a form and fashion conducive to the aims of healthcare quality and performance in population health management.
When I left my management role at Humana to enter into the startup world, I was shocked to find that a vast majority of Health Tech organizations are founded by innovators with non-healthcare backgrounds.

Healthcare Startups take too long to go to market hence innovations do not get to the American people in a form and fashion conducive to the aims of healthcare quality and performance in population health management.

When I left my management role at Humana to enter into the startup world, I was shocked to find that a vast majority of Health Tech organizations are founded by innovators with non-healthcare backgrounds.

I found that, in my conversations with startup leaders, they were overconfident and naive about the industry; about the many roadblocks and nuances of running a successful healthcare operation (ie. ‘Regulation Nation’, business complexity, and long ‘sales’ cycles become blockers to market entry).

Sadly and ultimately, this dynamic ‘kills’ otherwise life-changing innovations. We find this to be unfair. Not only to the startup but to the People. To you, Don. To me and my loved ones. These incredible inventions and ‘innovations’: dead on arrival; attributable to the founders’ lack of healthcare business navigational competency and expertise.

Educating the leaders was my first instinct (see me in action: Managed Care 101: Boot-camp for Healthcare Entrepreneurs).

Then, Carenodes Accelerator was born: a program along with outcomes not seen in the country. Programmatically, we provide an integrated suite of advisory, technological, data, clinical, and operational capabilities to ‘jumpstart’, or power, the startup on day 1.

We signed our first health technology startup in August 2020. Today, Carenodes has grown to 7 portfolio digital health startups. We are 100% fiscally self-sustained, fully bootstrapped, and led by a majority ‘minority’ team. Our leadership and downstream team composition is what the ‘equity and diversity’ movements of modern-day fantasize about.

As of the time of this correspondence, our startup medical groups have raised an aggregate of $210M in funding.

We have, in aggregate, provided 96,637 appointments to 36,718 patients (2019 – 2022) in 50 states + DC. We have accelerated Digital healthcare innovations to a scale now reaching 48 million Americans.

Net result on the US Healthcare System is: Access. Access for Payer, Provider & Patient. Not just one of these ‘nodes’ — but all.

By becoming ‘in-network’, the out-of-pocket burden for offerings based on ‘cash only’ direct-to-consumer strategies is reduced tremendously making it affordable for the consumer. At the same time, our digital health organizations generate (much) greater revenue by billing insurance and coordinating care in a way that is not incentivized in a cash-only model. Our medical group startups generate revenues in 6 months via health insurance network participation.

We provide a robust operation with clinical oversight beyond just ‘being an app’ on a cash model. Payers feel more comfortable with that type of organization. Hospitals and health systems trust the expertise and buy-in. Especially since insurance will be paying for the services.

This has benefited the startup, the patient, the payer, and us — the regular folks who NEED access.

What is our impact? See the following outcomes and have these figures speak for themselves:

Carenodes real-world implications and outcomes (from Oct 1, 2019 – Jan 1, 2022):

  • Using patented IoT-connected socks, we avoid 91% of all diabetic foot ulcer amputations.
  • Using FDA-approved AI technology, we monitor the hearts of CHF/HF (heart failure) patients at home and at skilled nursing facilities in NY and CA. Diverting 75% of avoidable ER utilization.
  • Using our 24/7 access to care platform, we have provided 66,467 virtual opioid use disorder treatment appointments.
  • Using our Biopsychosocial Network, we extend a highly coordinated ‘plug & play’ provider network of 134 health providers (and growing) to help ease the major challenges of workforce supply, recruitment, and management.
  • In connection with UCI and other major health systems, we are one of the very few delivery organizations providing Hospital at Home.
  • We have, in aggregate, provided 96,637 appointments to 36,718 patients (2019 – 2022) in 50 states + DC. We have accelerated Digital healthcare innovations to a scale now reaching 48 million Americans.

Here is a one-minute video update of our organizational position opening in the year 2022 (this clip is not made searchable on YouTube, but you should have access with the link).

CARES Act Telehealth Expansion: Trends in Post-Discharge Follow-Up and Association with 30-Day Readmissions for Hospital Readmissions Reduction Program Health Conditions

CARES Act Telehealth Expansion: Trends in Post-Discharge Follow-Up and Association with 30-Day Readmissions for Hospital Readmissions Reduction Program Health Conditions

 CARES Act Telehealth Expansion: Trends in Post-Discharge Follow-Up and Association with 30-Day Readmissions for Hospital Readmissions Reduction Program Health Conditions, 

As policymakers consider permanent telehealth policy changes, tracking the latest data has become increasingly important, in addition to breaking down data highlights and differences. Two new Centers for Medicare & Medicaid Services (CMS) Data Highlight reports were recently released that look at telehealth trends amongst Medicare patients during the pandemic. In addition, a Government Accountability Office (GAO)report submitted to Congress in early February assessed telehealth expansion impacts related to mental healthcare access for military service members. Key findings from the CMS data include that telehealth may reduce hospital readmission rates and disparities and improve opioid use disorder (OUD) treatment access. Meanwhile the GAO report showcased the importance of telehealth education to both providers and patients in ensuring access to care via telehealth.

CMS Data – Telehealth Impacts & Disparities on Follow-Up Care and OUD Treatment Access

The first CMS Data Highlight report, CARES Act Telehealth Expansion: Trends in Post-Discharge Follow-Up and Association with 30-Day Readmissions for Hospital Readmissions Reduction Program Health Conditions, looked at hospital readmission rates, which are typically viewed as key indicators in determining quality of care and potentially poor post-discharge follow-up care. CMS has sought to reduce excess readmissions over the years through its Hospital Readmissions Reduction Program, which assesses certain health conditions including heart failure, pneumonia and chronic obstructive pulmonary disease (COPD), as well as specific surgical procedures – coronary artery bypass and elective hip and/or knee replacements. As the brief notes, only with recent pandemic policy changes, has the ability to utilize and study telehealth as a modality for post-discharge follow-up care become possible.

The report used Medicare beneficiary sociodemographic data as well as Medicare claims data from April 1, 2019 – September 30, 2020 to look at hospitalizations and determine any notable telehealth impacts on post-discharge follow-up care and readmission rates within 30 days of discharge date. The study also assessed differences by modality, finding that synchronous audio/visual telehealth accounted for the majority of follow-up visits, with use increasing from 61%-69% while audio-only use decreased from 39%-31% during the same timeframe. Notably, the brief ultimately found no exacerbation of pre-COVID disparities in use of post-discharge follow-up, rather the findings suggest that continued telehealth policy expansions may help increase follow-up and reduce readmissions among underserved populations. However, given disparities in broadband access combined with finding potentially greater willingness and/or capacity of minority beneficiaries to adopt telehealth, the report cautions that if telephone visits are not maintained in permanent policies, some of the initial adoption could be at risk.

The second CMS Data Highlight report, Changes in Access to Medication Treatment during COVID-19 Telehealth Expansion and Disparities in Telehealth Use for Medicare Beneficiaries with Opioid Use Disorder, looked at access to medications for treating opioid use disorder (OUD). The data also pointed toward telehealth expansions improving access and found that beneficiaries accessing OUD care had lower use of inpatient and/or emergency department visits indicating that better access may reduce more costly care. Among OUD beneficiaries, few disparities in telehealth use were found based on race, ethnicity, or social deprivation levels, but there were disparities discovered based on Medicare eligibility, dual eligibility status, and rurality. Generally, Medicare beneficiaries over 65, beneficiaries not dually-eligible for Medicare and Medicaid, and those in rural areas were found to utilize telehealth less. Beneficiaries with the highest rates of utilization were those with OUD in addition to other more complex health needs.

GAO Study – DOD Audit Shows increase in Telehealth Utilization and Education

In early February, the GAO provided a report to Congress, Defense Health Care: DOD Expanded Telehealth for Mental Health Care during the COVID-19 Pandemic, that examined multiple sources, including relevant Department of Defense (DOD) policies and mental health reports from March 2020 to November 2021, as well as Defense Health Agency (DHA) utilization data from January 2019 to April 2021. Interviews across agencies and each branch of the military were also conducted for purposes of the study.

Focusing its findings on active duty servicemembers, pre-pandemic telehealth visits were found to make up 15% of mental health care visits, with that number increasing by 275% over the first few months of 2020 as the DOD shifted its care delivery in response to the pandemic. The utilization rates began decreasing by April of 2020 and in April 2021 were 33% of all mental health care visits. Some of the main policies found to accommodate the greater use of telehealth included disseminating information to mental health providers to assist them in delivering care via telehealth, amongst other provider resources. Online training was also provided and helpful information on mental health was provided to servicemembers as well. DOD officials stated the value of telehealth and its ability to improve access and continuity of care. In addition, officials suggested that telehealth may reduce the stigma of seeking mental health treatment by allowing servicemembers to receive care more privately without the risk of being seen in military treatment facilities.

Looking Ahead – Data Download

Access, disparities, and utilization continue to be issues of great interest in the latest studies and policymaker discussions around post-pandemic telehealth policy. While data may help inform necessary policy steps, findings continue to vary and much of the information available is largely limited to certain populations, modalities, services, and time periods. Therefore, it remains important that policymakers also keep data disparities in mind as to not inappropriately generalize specific findings while also allowing ample time for gathering more information before making any drastic conclusions or changes.

For more information on CMS Data Highlights and the two studies mentioned you can review the CMS website. Please access the GAO report in its entirety for its additional findings.

Nurse Practitioners Sentenced to Prison for Health Care Fraud

GREAT  FALLS – Two Montana nurse practitioners have been sentenced for conspiring to defraud Medicare of millions of dollars.  Chief U.S. District Judge Brian Morris sentenced Janae Nichole Harper, 34, of Kalispell, to 12 months in prison and Mark Allen Hill, 54, of Edinburg, North Dakota to 9 months in prison. 

GREAT  FALLS – Two Montana nurse practitioners have been sentenced for conspiring to defraud Medicare of millions of dollars.  Chief U.S. District Judge Brian Morris sentenced Janae Nichole Harper, 34, of Kalispell, to 12 months in prison and Mark Allen Hill, 54, of Edinburg, North Dakota to 9 months in prison. 

Both defendants will be placed on supervised release for 3 years after their release from prison.  Additionally, Harper was ordered to pay $4,307,934.58 in restitution and Hill was ordered to pay $5,054,866 in restitution.

Harper was a licensed nurse practitioner  in Montana, Missouri, Nevada, South Carolina and Wyoming and was enrolled as a medical provider with Medicare.  Hill was a licensed nurse practitioner in Montana, Iowa, Maine, Minnesota, North Dakota, South Dakota and Washington.

In court documents filed in Harper’s case, the government alleged that from Nov. 18, 2017 through July 16, 2019, Harper worked with certain staffing and telemedicine companies to commit health care fraud and received money to sign brace orders that were prepared by telemarketers who had no medical training or certification. Harper routinely signed these orders for Medicare beneficiaries regardless of medical necessity. Harper signed approximately 7,673 brace orders, which resulted in $8,259,849 billed to Medicare, of which Medicare paid approximately $4,307,934. Harper was paid at least $94,395 for the orders she signed.

Staffing and telemedicine companies to commit health care fraud and received money to sign brace orders that were prepared by telemarketers who had no medical training or certification.

U.S. Department of Health and Human Services

In court documents filed in Hill’s case, the government alleged that from Oct. 15,  2017 to April 24, 2019, Hill worked with certain staffing and telemedicine companies to commit health care fraud and received money to sign unnecessary brace orders for Medicare beneficiaries regardless of medical necessity, often without ever talking to the Medicare beneficiary to determine whether the braces were medically necessary.  Hill signed approximately 7,097 brace orders, which resulted in $10,055,436 billed to Medicare, of which Medicare paid approximately $5,054,866. Hill was paid at least $124,900 for the orders he signed.

Both defendants previously pled guilty to conspiracy to commit health care fraud. 

The cases were prosecuted by Assistant U.S. Attorney Michael A. Kakuk and Darren Halverson, Trial Attorney, and Robyn Pullio, former Trial Attorney, Fraud Section, Criminal Division of the Justice Department and investigated by the U.S. Department of Health and Human Services Office of Inspector General and the Federal Bureau of Investigation.

Telehealth Landscape Overview 50 States + DC

No two states are alike in how telehealth is defined and regulated. While there are some similarities in language, perhaps indicating states may have utilized existing verbiage from other states, noticeable differences exist. These differences are to be expected, given that each state defines its Medicaid policy parameters, but it also creates a confusing environment for telehealth participants to navigate, particularly when a health system or practitioner provides health care services in multiple states. In most cases, states have moved away from duplicating Medicare’s restrictive telehealth policy, with some reimbursing a wide range of practitioners and services, with little to no restrictions.

One of the most common trends with live video reimbursement was the addition of eligible services to the list of telehealth eligible services, with applied behavioral analysis being the most common service addition mentioned in Medicaid manuals.

Additionally, in the wake of the COVID-19 pandemic, some states do seem to be adopting the Center for Medicare and Medicaid Services (CMS) communication technology-based services (CTBS) codes, including the virtual check-in and remote evaluation of prerecorded information, audio-only service codes and remote physiologic monitoring. All fifty states and the District of Columbia have a definition in law, regulation, or their Medicaid program for telehealth, telemedicine, or both.

Additionally, because of the allowance in most states to utilize telephone as a form of telehealth during COVID-19, some states are taking steps to broaden its permanent definitions of telehealth or telemedicine by removing the explicit exclusion of telephone or including audio-only services within the definition itself. One of the states with the most significant changes to their telehealth policy was Massachusetts which passed a comprehensive telehealth law to require reimbursement for both Medicaid and private payers if the services are covered in-person and it is appropriately delivered through telehealth. The law contained some unique elements including specifying that the rate of payment for telehealth services provided via interactive audio-video technology and audio-only telephone may be greater than the rate of payment for the same services delivered by other telehealth modalities. It also provided payment parity for in-network providers of behavioral health services delivered via interactive audio-video technology or audio-only telephone only.

Additional findings include:

  • 50 states and Washington DC provide reimbursement for some form of live video in Medicaid fee-for-service.
  • 22 state Medicaid programs reimburse for store-and-forward. However, three states (NC, OH, VT) solely reimburse store-and-forward asa part of CTBS, which is limited to specific codes and reimbursement amounts. Additionally, three  jurisdictions (MS, NH, and NJ) have laws requiring Medicaid reimburse for store-and-forward but as of this time, have yet to have anyofficial Medicaid policy indicating this is occurring. 
  • 26 state Medicaid programs provide reimbursement for RPM. As is the case for store and-forward, two Medicaid programs (HI and NJ) have laws requiring Medicaid reimburse for RPM but at the time this response was written, did not have any official Medicaid policy. Additionally, one state (Ohio) only reimburses the remote physiologic monitoring codes CMS does.
  • 14 state Medicaid programs (Alaska, Arizona, Colorado, Maryland, Maine, Minnesota, Missouri, North Carolina, New York, Ohio, Oregon,Texas, Vermont and Virginia) reimburse for all three, although certain limitations apply.
  • 43 states and the District of Columbia have laws that govern private payer reimbursement of telehealth. Some laws require reimbursement be equal to in-person coverage, however most only require parity in covered services, not reimbursement amount. Not all laws mandate reimbursement coverage parity, and very few have explicit payment parity

Florida Market Telehealth Rule & Controlled Substances

Rules regarding telehealthcare in Florida.

During the 2019 legislative session, Florida passed Chapter 2019-137, Laws of Florida, which establishes standards of practice for telehealth services, including patient evaluations, record-keeping, and controlled substances prescribing. The law also authorizes out-of-state health care practitioners to perform telehealth services for patients in Florida. Signed by the Governor on June 25, 2019, this law became effective on July 1, 2019.

Out-of-state health care practitioners must be registered with the Florida Department of Health to perform telehealth services for patients in Florida.

Health care providers must be licensed within their scope of practice by the appropriate licensing body to practice telehealth in Florida.

Providers must also use two-way, interactive communication tools, such as live video, instead of email or audio-only communication. If you use Medicaid, your telehealth provider must be registered with the Florida Medicaid program to receive reimbursement for telehealth services. Florida doesn’t require private insurers to cover telehealth, so check with your insurance company to determine if you’re eligible for the service. Some of these regulations may be altered during the COVID-19 pandemic.

In Florida, telehealth providers are permitted to prescribe medications if the medications aren’t listed as controlled substances.

Controlled substances shall not be prescribed through the use of telemedicine except for the treatment of psychiatric disorders. This provision does not preclude physicians from ordering controlled substances through the use of telemedicine for patients hospitalized in a facility licensed pursuant to Chapter 395, F.S.

Telemedicine Rule, Rule 64B8-9.0141, F.A.C.

However, there is one important exception to this rule: If you need a controlled substance to manage a mental health condition, your telehealth provider is allowed to prescribe it.

Before prescribing medication, your telehealth provider must conduct an evaluation and explain the risks and benefits of the medication to you.

Filling out a questionnaire before your telehealth appointment isn’t enough to satisfy the evaluation requirement, so you should expect the provider to ask multiple questions about your symptoms and health history.

ALTERNATIVE CARE SETTINGS: TELEMEDICINE AND RETAIL CLINICS

Many firms provide coverage for health services delivered outside typical provider settings. Telemedicine is the delivery of health care services through telecommunications to a patient from a provider who is at a remote location, including video chat and remote monitoring. This generally would not include the mere exchange of information via email, exclusively web-based resources, or online information a plan may make available unless a health professional provides information specific to the enrollee’s condition. We note that during the coronavirus pandemic, some plans have eased their definitions to allow more types of digital communication to be reimbursed.

How alternative settings unlock healthcare access — and eat into hospitals

















	


	





	

		
		
2021 Performance Period Eligible Professional / Eligible Clinician eCQMs
	


				

				
The document outlines 47 electronic clinical quality measures (eCQMs) for Eligible Professionals/Clinicians for the 2021 performance period. It categorizes various measures based on quality domains, including effective clinical care, community health, and patient safety, while indicating eligibility for telehealth in select measures.

			

			
	
	

		

2021 Performance Period Eligible Professional / Eligible Clinician eCQMs
Total number of EP/EC eCQMs: 47





Measure NameCMS eCQM IDQuality DomainNQF IDMIPS Quality IDMeaningful Measure AreaTelehealth Eligible*
Adult Major Depressive Disorder (MDD): Suicide Risk AssessmentCMS161v9Effective Clinical Care0104e107Prevention, Treatment, and Management of Mental HealthYes
Anti-depressant Medication ManagementCMS128v9Effective Clinical CareNot Applicable009Prevention, Treatment, and Management of Mental HealthYes
Appropriate Testing for PharyngitisCMS146v9Efficiency and Cost ReductionNot Applicable066Appropriate Use of HealthcareYes
Appropriate Treatment for Upper Respiratory Infection (URI)CMS154v9Efficiency and Cost ReductionNot Applicable065Appropriate Use of HealthcareYes
Appropriate Use of DXA Scans in Women Under 65 Years Who Do Not Meet the Risk Factor Profile for Osteoporotic FractureCMS249v3Efficiency and Cost Reduction3475e472Appropriate Use of HealthcareYes
Bone density evaluation for patients with prostate cancer and receiving androgen deprivation therapyCMS645v4Effective Clinical CareNot Applicable462Management of Chronic ConditionsYes
Breast Cancer ScreeningCMS125v9Effective Clinical CareNot Applicable112Preventive CareYes
Cataracts: 20/40 or Better Visual Acuity within 90 Days Following Cataract SurgeryCMS133v9Effective Clinical Care0565e191Management of Chronic ConditionsNo
Cervical Cancer ScreeningCMS124v9Effective Clinical CareNot Applicable309Preventive CareYes
Child and Adolescent Major Depressive Disorder (MDD): Suicide Risk AssessmentCMS177v9Patient Safety1365e382Prevention, Treatment, and Management of Mental HealthYes
Childhood Immunization StatusCMS117v9Community/Population HealthNot Applicable240Preventive CareYes
Children Who Have Dental Decay or CavitiesCMS75v9Community/Population HealthNot Applicable378Preventive CareNo
Chlamydia Screening for WomenCMS153v9Community/Population HealthNot Applicable310Preventive CareYes
Closing the Referral Loop: Receipt of Specialist ReportCMS50v9Communication and Care CoordinationNot Applicable374Transfer of Health Information and InteroperabilityYes
Colorectal Cancer ScreeningCMS130v9Effective Clinical CareNot Applicable113Preventive CareYes
Controlling High Blood PressureCMS165v9Effective Clinical CareNot Applicable236Management of Chronic ConditionsYes
Coronary Artery Disease (CAD): Beta-Blocker Therapy-Prior Myocardial Infarction (MI) or Left Ventricular Systolic Dysfunction (LVEF <40%)CMS145v9Effective Clinical Care0070e007Management of Chronic ConditionsYes
Dementia: Cognitive AssessmentCMS149v9Effective Clinical Care2872e281Prevention, Treatment, and Management of Mental HealthYes
Depression Remission at Twelve MonthsCMS159v9Effective Clinical Care0710e370Prevention, Treatment, and Management of Mental HealthYes
Diabetes: Eye ExamCMS131v9Effective Clinical CareNot Applicable117Management of Chronic ConditionsYes
Diabetes: Hemoglobin A1c (HbA1c) Poor Control (> 9%)CMS122v9Effective Clinical CareNot Applicable001Management of Chronic ConditionsYes
Diabetes: Medical Attention for NephropathyCMS134v9Effective Clinical CareNot Applicable119Management of Chronic ConditionsYes
Diabetic Retinopathy: Communication with the Physician Managing Ongoing Diabetes CareCMS142v9Communication and Care CoordinationNot Applicable019Transfer of Health Information and InteroperabilityNo
Documentation of Current Medications in the Medical RecordCMS68v10Patient Safety0419e130Medication ManagementYes
Falls: Screening for Future Fall RiskCMS139v9Patient SafetyNot Applicable318Preventable Healthcare HarmYes
Follow-Up Care for Children Prescribed ADHD Medication (ADD)CMS136v10Effective Clinical CareNot Applicable366Prevention, Treatment, and Management of Mental HealthYes
Functional Status Assessment for Total Hip ReplacementCMS56v9Person and Caregiver-Centered Experience and OutcomesNot Applicable376Functional OutcomesYes
Functional Status Assessment for Total Knee ReplacementCMS66v9Person and Caregiver-Centered Experience and OutcomesNot Applicable375Functional OutcomesYes
Functional Status Assessments for Congestive Heart FailureCMS90v10Person and Caregiver-Centered Experience and OutcomesNot Applicable377Functional OutcomesYes
Heart Failure (HF): Angiotensin-Converting Enzyme (ACE) Inhibitor or Angiotensin Receptor Blocker (ARB) or Angiotensin Receptor-Neprilysin Inhibitor (ARNI) Therapy for Left Ventricular Systolic Dysfunction (LVSD)CMS135v9Effective Clinical Care0081e005Management of Chronic ConditionsYes
Heart Failure (HF): Beta-Blocker Therapy for Left Ventricular Systolic Dysfunction (LVSD)CMS144v9Effective Clinical Care0083e008Management of Chronic ConditionsYes
HIV ScreeningCMS349v3Community/Population HealthNot Applicable475Preventive CareYes
Initiation and Engagement of Alcohol and Other Drug Dependence TreatmentCMS137v9Effective Clinical CareNot Applicable305Prevention and Treatment of Opioid and Substance Use DisordersYes
Oncology: Medical and Radiation – Pain Intensity QuantifiedCMS157v9Person and Caregiver-Centered Experience and Outcomes0384e143Management of Chronic ConditionsYes
Pneumococcal Vaccination Status for Older AdultsCMS127v9Community/Population HealthNot Applicable111Preventive CareYes
Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up PlanCMS69v9Community/Population HealthNot Applicable128Preventive CareNo
Preventive Care and Screening: Influenza ImmunizationCMS147v10Community/Population Health0041e110Preventive CareYes
Preventive Care and Screening: Screening for Depression and Follow-Up PlanCMS2v10Community/Population Health0418e134Prevention, Treatment, and Management of Mental HealthYes
Preventive Care and Screening: Screening for High Blood Pressure and Follow-Up DocumentedCMS22v9Community/Population HealthNot Applicable317Preventive CareNo
Preventive Care and Screening: Tobacco Use: Screening and Cessation InterventionCMS138v9Community/Population Health0028e226Prevention and Treatment of Opioid and Substance Use DisordersYes
Primary Caries Prevention Intervention as Offered by Primary Care Providers, including DentistsCMS74v10Effective Clinical CareNot Applicable379Preventive CareYes
Primary Open-Angle Glaucoma (POAG): Optic Nerve EvaluationCMS143v9Effective Clinical Care0086e012Management of Chronic ConditionsNo
Prostate Cancer: Avoidance of Overuse of Bone Scan for Staging Low Risk Prostate Cancer PatientsCMS129v10Efficiency and Cost Reduction0389e102Appropriate Use of HealthcareNo
Statin Therapy for the Prevention and Treatment of Cardiovascular DiseaseCMS347v4Effective Clinical CareNot Applicable438Management of Chronic ConditionsYes
Urinary Symptom Score Change 6-12 Months After Diagnosis of Benign Prostatic HyperplasiaCMS771v2Person and Caregiver-Centered Experience and OutcomesNot Applicable476Functional OutcomesNo
Use of High-Risk Medications in Older AdultsCMS156v9Patient SafetyNot Applicable238Medication ManagementYes
Weight Assessment and Counseling for Nutrition and Physical Activity for Children and AdolescentsCMS155v9Community/Population HealthNot Applicable239Preventive CareYes

	


	





	

		
		
Updates to UnitedHealthcare Cost-Share Waivers
	


				

				
To ensure members are able to access the care they need as the COVID-19 pandemic continues, UnitedHealthcare is expanding cost share waivers for our Medicare Advantage and Individual and Group Market health plans for certain services. Here’s a high-level 

			

			
	
	

		

The following provides healthcare providers and patients with information surrounding cost-share (copays, etc.) and applicable policies as enacted by United Healthcare (UHC).





Not ALL patients covered by UHC are implicated — please read the line of business (Medicare, type of commercial insurance, etc.) before making potentially detrimental changes in your cost-share collections.





PRIMARY CARE PROVIDERS WITH UHC PATIENTS, NEW POLICIES APPLY TO YOU
To ensure members are able to access the care they need as the COVID-19 pandemic continues, UnitedHealthcare is expanding cost-share waivers for our Medicare Advantage and Individual and Group Market health plans for certain services. Here’s a high-level summary of the changes.







New! Medicare Advantage Primary Care
Care Oct. 1, 2020 through Dec. 31, 2020, UnitedHealthcare is waiving cost share for Medicare


New! Medicare Advantage Primary Care
From Oct. 1, 2020 through Dec. 31, 2020, UnitedHealthcare is waiving cost share for Medicare Advantage plan members for primary care professional services. This applies to in-network and covered out-of-network COVID-19 and non-COVID-19 visits, whether they are conducted in-office or via telehealth.







Telehealth Originating Site Requirements (no changes since 9/28/20)


Telehealth Originating Site Requirements (no changes since 9/28/20)





The updates to originating site requirements that we announced on Sept. 28, 2020 have not changed.





  • Individual and fully insured Group Market health plans: 
    • For Individual and fully insured Group Market health plans, there are changes related to COVID-19 and non-COVID-19 telehealth visits, as well as for in- and out-of-network providers. You’ll also find state-specific rules, regulations and emergency periods on the State Provision Exception page. These may vary from federal regulations. If no state-specific exceptions apply, UnitedHealthcare guidelines will apply.
      • COVID-19 and non-COVID-19 in-network telehealth visits: The expansion of telehealth access is extended through Dec. 31, 2020.* This means health care professionals can temporarily provide telehealth services by a live interactive audio-video or audio-only communications system for members at home or another location. For more details on telehealth billing guidance and provider type eligibility, visit UHCprovider.com/covid19.
      • COVID-19 out-of-network telehealth visits: The expansion of telehealth access for out-of-network providers ends Oct. 22, 2020. As of Oct. 23, 2020, out-of-network telehealth services are covered according to the member’s benefit plan and UnitedHealthcare’s telehealth reimbursement policy.*
      • Non-COVID-19 out-of-network telehealth visits: The expansion of telehealth access for out-of-network providers ended July 24, 2020. As of July 25, 2020, out-of-network telehealth services are covered according to the member’s benefit plan and UnitedHealthcare’s telehealth reimbursement policy.





Medicare Advantage:





  • COVID-19 and non-COVID-19 in-network telehealth visits: The expansion of telehealth access is extended through Dec. 31, 2020. Any originating site requirements that apply under Original Medicare are temporarily waived, so that telehealth services provided through live interactive audio-video can be billed for members at home or another location.





  • COVID-19 and non-COVID-19 out-of-network telehealth visits: The expansion of telehealth access is extended through the national public health emergency period, currently scheduled to end Oct. 22, 2020.*







Medicare Advantage COVID-19 Treatment


Cost share waivers (copay, coinsurance and deductible) for COVID-19 testing and testing-related visits are extended through Dec. 31, 2020 for our Medicare Advantage health plans. This applies to in-network and covered out-of-network COVID-19 treatment.







COVID-19 Treatment 


Individual and Group Market health plans: 





Cost share waivers (copay, coinsurance and deductible) for in-network COVID-19 treatment are extended through Dec. 31, 2020. Out-of-network cost share waivers will end Oct. 22, 2020. Implementation for self-funded customers may vary.





Medicare Advantage: 





Cost share waivers (copay, coinsurance and deductible) for COVID-19 treatment are extended through Dec. 31, 2020. This applies to in-network and covered out-of-network COVID-19 treatment.







COVID-19 and non-COVID-19 out-of-network telehealth visits: 


  • Individual and fully insured Group Market health plans: For Individual and fully insured Group Market health plans, there are changes related to COVID-19 and non-COVID-19 telehealth visits, as well as for in- and out-of-network providers. You’ll also find state-specific rules, regulations and emergency periods on the State Provision Exception page. These may vary from federal regulations. If no state-specific exceptions apply, UnitedHealthcare guidelines will apply.





  • COVID-19 and non-COVID-19 in-network telehealth visits: The expansion of telehealth access is extended through Dec. 31, 2020.* This means health care professionals can temporarily provide telehealth services by a live interactive audio-video or audio-only communications system for members at home or another location. For more details on telehealth billing guidance and provider type eligibility, visit UHCprovider.com/covid19.
  • COVID-19 out-of-network telehealth visits: The expansion of telehealth access for out-of-network providers ends Oct. 22, 2020. As of Oct. 23, 2020, out-of-network telehealth services are covered according to the member’s benefit plan and UnitedHealthcare’s telehealth reimbursement policy.*
  • Non-COVID-19 out-of-network telehealth visits: The expansion of telehealth access for out-of-network providers ended July 24, 2020. As of July 25, 2020, out-of-network telehealth services are covered according to the member’s benefit plan and UnitedHealthcare’s telehealth reimbursement policy.





Medicare Advantage:





  • COVID-19 and non-COVID-19 in-network telehealth visits: The expansion of telehealth access is extended through Dec. 31, 2020. Any originating site requirements that apply under Original Medicare are temporarily waived, so that telehealth services provided through live interactive audio-video can be billed for members at home or another location.
  • COVID-19 and non-COVID-19 out-of-network telehealth visits: The expansion of telehealth access is extended through the national public health emergency period, currently scheduled to end Oct. 22, 2020.*