As the state continues to push home care as a way to reduce long-term health care costs, lawmakers are looking to insurers to help foot the bill.
State legislators are proposing a new mandate that would require health insurers to cover medical services provided through telemedicine, an increasingly popular form of home care that allows physicians, nurses and other caregivers to treat or advise patients without face-to-face contact using electronic information or telecommunications technologies.
The bill applies to individual and group health insurance policies and requires coverage for the use of interactive audio, video, or data communication for delivering medical advice, diagnosis, care or treatment.
The proposal, which has already passed out of the Insurance and Real Estate Committee, has garnered support from the state’s home care industry, but has raised red flags from business and insurance lobbyists, who view it as another state mandate that will raise the cost of insurance.
Supporters say telemedicine, which can take various forms, can help reduce health care costs by keeping chronically ill patients at home rather than at higher cost centers, like a hospital or nursing home facility.
Vernon’s Visiting Nurse & Health Services of Connecticut, for example, has used telemedicine services since 2002 and the technology has helped reduce hospital readmission rates for its chronically ill heart failure patients by 10 percentage points, said Rosemary Harding, the nonprofit’s vice president of clinical services.
The care provider offers about 200 patients bedside touch screen monitors that collect blood pressure, pulse, oxygen, weight and glucose level data that gets transmitted to medical assistants who oversee a patient’s care.
If numbers are out of whack, a care provider will contact the patient by phone to see if there may be a problem or if they need to adjust their medications.
The service provides peace of mind to patients like 75-year-old John Bundy, a retired Vernon police captain who has used the bedside monitor on and off for about a year.
Before using the monitor, Bundy, who has been through several surgeries since last summer, said he never paid much attention to his medical data.
Now he takes his takes his weight, blood pressure and glucose levels every morning, inputs the information into the bedside portal and even keeps a handwritten diary of his health history.
Bundy said the service not only allows him to avoid having to visit a physician more often, but it keeps him much more informed about his personal health so that he can address issues before they get severe.
“If I didn’t have this to start with, I would probably get much sicker before I did anything about it,” Bundy said.
Telemedicine, Harding says, allows chronically ill patients to learn how to manage their care at home, rather than depending on emergency rooms or a nursing home.
But there’s a cost issue.
Visiting Nurse & Health Services of Connecticut isn’t getting reimbursed by commercial payers for the service, although Medicare does provide some help. Instead the organization has used donor money to help cover expenses, which include the purchase and/or renting of equipment.
Deborah Hoyt, president and CEO of the Connecticut Association for Healthcare at Home, said more than half of the 60 homecare company members use some form of telemonitoring, but its use would likely be more widespread if there were better reimbursement policies in place.
Hoyt said Connecticare is the only insurer she is aware of that reimburses home health agencies for telemonitoring, but it’s restricted to cardiac health plan members.
At an average cost per day of $8 to $10 for a telemonitor — with the average use per patient being about 90 days — many home care agencies are paying out of pocket to cover the service, she said.
Both the Connecticut Business & Industry Association and Connecticut Association of Health Plans submitted written testimony opposing the expansion of insurance coverage for telemedicine.
Health mandates have been a hot political issue in Connecticut for years. The business community has long voiced opposition, citing costs. The divide illustrates a central issue in the broader health care debate. The question of how to control health care costs, while also mandating adequate coverage that prevents and treats illnesses effectively, has been difficult to answer.
According to a report by the Council for Affordable Health Insurance (CAHI), which is funded by the insurance industry, Connecticut had 65 mandates at the end of 2012, making it the fifth most demanding state.
While mandates make health insurance more comprehensive, they also make it more expensive, requiring insurers to pay for care patients previously funded out of their own pocket. Those expenses often get passed onto employers through higher premiums.
Insurers are not totally opposed to the telemedicine concept and have actually been experimenting with it for years. But insurers say they are still uncertain about its true cost savings.
Just last week Bloomfield health insurer Cigna Corp. said it is partnering with Florida technology company MDLIVE to give its self-insured customers access to round-the-clock, online video or telephone consultations with board-certified physicians.
The virtual consults aim to resolve non-emergency medical issues like allergies, pink eye and sinus infections, in less than one hour. It is not aimed at dealing with chronically ill patients.
Cigna spokesman Joe Mondy said Cigna has been offering reimbursable “virtual house calls” nationally since 2007, but the company views it as more of a convenience service, rather than a major cost saver.
“If it will save money is yet to be determined,” Mondy said. “What could happen is folks could do telehealth and then go to the doctors. You may actually be adding to costs. It’s more about convenience of care.”
