Even before the COVID-19 pandemic, telehealth services represented a growing area of the health care business. Now, with hospitals and local medical practices stretched and patients unwilling or unable to leave their homes, remote consultations are more important than ever. NJBIZ conducted an email interview about the subject with Paul Marden, the CEO of UnitedHealthcare, New Jersey. The interview has been edited for length and clarity.
NJBIZ: First, how are you, your family and your staff doing? And what are you hearing from your customers? How are they getting on?
Paul Marden: This is a challenging time for our country, especially in New Jersey. Gratefully, my family and I are currently healthy, and UnitedHealthcare acted quickly to move as many team members as possible to working from home. We do employ numerous clinicians, some of whom are now delivering vital care. We appreciate those efforts – and the efforts of all health care providers – during these difficult times.
We are working hard to help meet the needs of the communities we serve in New Jersey and across the country. For instance, we announced a $1 million grant for Food Bank of New Jersey to help those in need. Right now, it’s all about waking up every day and asking, “How can we use our resources, experience, and expertise to help make a positive difference during this unprecedented public health emergency.” Expanding our telehealth resources is one way we are meeting that challenge.
Ultimately, our mission is to help people live healthier lives and make the health system work better for everyone – and that continues now more than ever as we pull together as an industry, as a state and as a nation to overcome the COVID-19 emergency.
Q: On the subject at hand, it seems as though telehealth should be an important part of the health care system right now. Are you seeing providers and patients use it to the extent they should?
A: The COVID-19 situation is potentially a watershed moment in the adoption of telehealth services in New Jersey and across the country. While many health plans and medical experts have long touted telehealth’s potential to help improve access to care that may be more affordable and convenient, widespread adoption has been relatively slow.
That has changed during the recent weeks and months. With shelter-in-place orders in New Jersey and states nationwide, we are seeing a significant surge in the number of people using digital devices to remotely access care and medical advice. And once people try telehealth, in many cases they have a positive experience: Previous research shows 68 percent of patients rated their telemedicine visit a “nine” or “10” on a 10-point satisfaction scale, and 74 percent had their care concern resolved during the first visit.
As we all continue to navigate the COVID-19 situation, we anticipate continued adoption of telehealth resources. People are increasingly recognizing telehealth as a first-line option for medical advice related to COVID-19, in part to help avoid potential exposure risks associated with in-person trips to care providers and health care facilities.
Q: And are they using the technology correctly? If not, what resources are available to help patients avail themselves of the service?
A: There are a few possible options people should consider when looking to access telehealth resources. As a starting point, people should check with their care provider group, health benefit plan or employer to determine if these services may be available to them.
To further help encourage use, the state of New Jersey required fully insured health plans to temporarily grant access to telehealth visits related to COVID-19 without cost sharing (and, if needed, waiving subsequent cost sharing for treatment under eligible plans). Since the outbreak emerged, the state mandate also requires waiving of cost sharing when patients use telephone-only or other communications technology, including live videoconferencing, to connect with local network medical providers. This requirement applies to in-network and out-of-network telehealth providers, spanning disciplines such as behavioral health, physical therapists, occupational therapists and speech therapists.
These efforts are designed to help make telehealth more widely available for more New Jersey residents as a first-line option to help evaluate and manage COVID-19 infections.
Q: How robust are telehealth consultations? And how can doctors and patients help ensure that care is delivered appropriately and on a continuing basis?
A: During a telehealth visit, care providers can give general medical advice to evaluate possible COVID-19 symptoms (such as fever, dry cough or difficulty breathing) and a range of other health ailments. While diagnostic testing services are not available through a telehealth visit to help confirm a diagnosis for COVID-19 (if needed), care providers can help guide patients to a local care provider or public health authority for testing and follow-up care.
Making these connections may help people take the appropriate steps in advance of an in-person test, which may help reduce the risk of an individual’s exposure and possible exposure to other patients and health care providers. Another key development is the recent effort to help make it easier for people to connect people with their local network medical providers via telephone or videoconferencing. This may be especially important for people with certain complex conditions, such as diabetes or Parkinson’s disease, as it may enable them to “see” their own physician for acute or follow-up care related to their condition.
Moving forward, we anticipate telehealth and remote-patient monitoring technologies – such as continuous blood glucose monitors – playing a growing role in promoting well-being, as well as supporting disease detection and prevention.
Q: Are some conditions less appropriate for a telehealth consultation than others?
A: Telehealth may help address myriad medical issues, including allergies, pinkeye, fevers, rashes and the regular flu. Historically, telehealth has been most widely used for non-emergency medical issues. For certain illnesses (not COVID-19 related) that are treatable with medications, telehealth care providers can write prescriptions and discuss how to obtain them safely, such as using medication home delivery or drive-thru pick up at a local pharmacy. Especially during this public health emergency, patients who need continued follow-up care with a physician due to complex chronic conditions, telehealth provides the means for them to remotely meet with their own doctor without the need for an in-person visit.
Telehealth is also emerging as a helpful resource for behavioral health services, to help make it more convenient for people to access this type of care. Due to COVID-19 requiring many people to spend more time alone and likely contributing to feelings of anxiety and depression, telehealth is an important resource to connect with a qualified behavioral health professional (e.g., a nurse practitioner, psychiatrist, psychologist, physician assistants or licensed counselor). Increasingly, telehealth may be used for other types of care, including primary, specialty and dental and vision services, with recent federal guidelines enabling for greater use of tele-optometry during this unique time.
It is important to remember that people who experience a significant or serious medical issue should go to the emergency room.
Q: Is technology available widely enough – and easy enough to use — to make telehealth a viable option for most patients?
A: There have been significant strides in recent years, including recent efforts by the federal government, to expand the availability of telehealth resources. In fact, nearly nine out of 10 employers offer telehealth visits to their employees, as do many Medicare and Medicaid health plans (in some cases by telephone), and 76 percent of hospitals connect patients and care providers using video or other technology. Some employers are even offering financial incentives – such as a gift card – to encourage people to try telehealth.
At UnitedHealthcare, the majority of our members enrolled in employer-sponsored and individual plans can connect 24/7 with a health care provider via a telephone, smartphone, tablet or personal computer. Through our app, eligible members can directly schedule and conduct a virtual visit with a doctor, helping eliminate the need for multiple sign-ins or to download a separate app.
With recently enacted federal guidelines that temporarily relax telehealth regulations, UnitedHealthcare is encouraging all care providers use telehealth to care for their patients rather than in-person office visits. To that end, we have temporarily made reimbursement rates for office visits the same whether care is delivered virtually or in person, helping encourage care providers to continue delivering routine medical services to their patients.
Helping make telehealth widely available – and widely used – may be able to provide consumers improved safety, convenience and lower costs.
Q: Relatedly, has the pandemic had any adverse effects on the provision of telehealth services?
A: Due to the COVID-19 situation, virtual care providers experienced a surge in appointments, so people have been experiencing longer wait times to access an appointment compared to a few months ago. Fortunately, as care providers quickly ramped up capacity, those wait times have been coming down.
Q: And if the COVID-19 outbreak continues into the summer, do health care providers have the resources to sustain telehealth services over a long period?
A: We are confident telehealth resources will continue to be readily available to our members who have these services available to them under their health plan. The care providers we collaborate with have been adding more doctors to their platforms, while investing in their technological infrastructure to accommodate surging demand. For instance, our sister company, Optum, during the last few weeks ramped up the number of contracted care providers on its telehealth network from 1,000 to 5,000.
We all hope the COVID-19 outbreak is contained as quickly as possible, although we will continue preparing to help support our members and monitor the situation as it continues to evolve.
Q: In the past, some health care providers had some concerns about reimbursement levels. Are those concerns still warranted?
A: As an organization, we have responded quickly to the COVID-19 emergency to help make it easier for health care providers to deliver medical services virtually. In fact, our network care providers are able to offer virtual appointments – via video conference or telephone – and temporarily receive reimbursement at the same rate as an in-person office visit. We know this is an important step to help support our members and our network care providers as they strive to deliver quality, evidence-based care.
Q: Finally, should patients be concerned about their privacy, given the prevalence of hacks and other breaches? If not, what safeguards are in place?
A: Data security and privacy are of the utmost importance for UnitedHealthcare. As an organization, we remain constantly vigilant and are continuously investing in technology safeguards and encryption techniques that help us maintain a secure environment, while remaining compliant with all federal and state privacy requirements.
This article also appears in the April 27, 2020 Edition of NJBIZ, which you can find here.