Telehealth coverage rolls back across United States

Marlene Maheu, Ph.D, executive director of Telebehavioral Health Institute (TBHI) in San Diego, California.

New England tries to hang on

If there was an upside to the pandemic, it was telehealth. For many patients, particularly those with mental health issues, telehealth was both convenient and necessary. Unfortunately, now that insurance coverage is increasingly rolling back, patients and clinicians are feeling concerned.

For example, Virginia announced late last year that telehealth visits were “no longer feasible” to thousands of clients. Some private insurance companies rolled back coverage as early as June 2020, with coronavirus levels spiking globally.

In the New England states, Maine, Massachusetts, and New Hampshire had their pandemic-related waivers expire last summer. However, Massachusetts Governor Charlie Baker signed a bill in January 2022 to, in part, expand telehealth services.

Rhode Island’s waiver expired in August 2021 with a caveat that providers who wished to continue care could apply for licensure in the state.

Vermont’s waiver expired in 2021, however Governor Scott signed a bill extending it until the end of March 2022.

Connecticut remains the only New England state to keep telehealth coverage until 2023. The Centers for Medicare and Medicaid also recently stated their coverage would continue through 2023.

But what does that mean for the future?

The answer may depend on which healthcare plan you have. According to an October 15, 2021, Kaiser Health News report, some insurance plans are requiring the first visit for non-emergency primary care to be online.

For example, Harvard Pilgrim Health Care, serving Connecticut, Maine, and New Hampshire, has such a plan.

But while online visits are easily accessible for most people, many see a downside, particularly when it comes to mental health care. The body language necessary for some practitioners to pick up on bigger problems can be muted.

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Michael Koren, Psy.D, clinical psychologist at Brighter Life Therapy in Cambridge, Mass.

Michael Koren, Psy.D, clinical psychologist at Brighter Life Therapy in Cambridge, Mass., said that’s one of the negatives in telehealth.

“Telehealth has its challenges,” he said. “I rely a lot on non-verbal communication and it’s difficult to track eye movement on a video screen. With eye movement, I can also gauge interest or attention, whereas in a video they actually might be looking at something else.”

Koren noted there are patients who benefit from telehealth—those who are more “high functioning”—while others with more severe issues would be better off face to face with their practitioner. “I also don’t have to worry about suicidality in high functioning patients,” he said.

Marlene Maheu, Ph.D, executive director of Telebehavioral Health Institute (TBHI) in San Diego, Calif., reiterated Koren’s viewpoint.

“The best candidates for telehealth are those that are less disordered than others. It can help anybody if they are in a safe environment,” she said. “It works if people have enough privacy to speak in confidence, if they are not suicidal or in an abusive situation.”

Kelli Scott, Ph.D, is a clinical psychologist and assistant professor of behavioral and social sciences and psychiatry and human behavior at Brown University in Providence, Rhode Island.

Kelli Scott, Ph.D, is a clinical psychologist and assistant professor of behavioral and social sciences and psychiatry and human behavior at Brown University in Providence, Rhode Island. A researcher, Scott works with opioid treatment facilities. As far as she’s concerned, there’s no reason to stop telehealth when it has meant better patient care.

“Specifically, what we’ve seen for opioid users is less restrictive care for frequent counseling sessions or the need for medications on a daily basis. There’s better access and increased flexibility,” she said. “It’s controlled care in a less stigmatizing way. That’s been a huge improvement. Overall, it’s been a good thing. I’m a big advocate for it to continue and to be covered.”

Telehealth may benefit patients and increase their access to therapy. However, there’s still some skepticism regarding its usefulness. In a November 3, 2021, “Consumer Affairs” article, a research study conducted by the University of Cambridge showed mixed feelings among patients.

Having direct access to their doctors was certainly convenient, however “others are questioning the accuracy of the health advice given during these sessions.”

Koren noted some studies have shown that telehealth is equal in efficacy to in-person sessions, but he has his doubts. “It promotes greater access, yes. But I think there’s a bias there,” he said. “Ultimately, it’s gone pretty well. But there’s no way it can be 100 percent equal to in-person.”

His patients have been experiencing depression and anxiety, issues also present before COVID-19. The problems have only exacerbated.

“What I am seeing is relationship issues—marital discord, issues with friends, parents, other family. Setting boundaries, because we’ve been more together for longer periods of time so there’s no escape,” said Koren. “I’m also seeing a lot of grief. People’s loss from death, they can’t attend to their bereavement properly because of pandemic restrictions. But also, there’s a grief of their old lifestyle.”

Could telehealth be a thing of the past?

Maheu, whose organization was one of the first interprofessional telehealth training institutes and continues to lead the industry, doesn’t believe so. Maheu, in fact, has been addressing telehealth publicly since the mid-1990s and has been published extensively on the subject.

The research is clear, she noted. There’s no question about the efficacy of telehealth for many patients. However, there are two main obstacles. She said the number one barrier is practitioner reluctance. In her experience, many practitioners are untrained and under-prepared.

The number two barrier is insurance coverage. She said the name of the game is to collect premiums without a payout. “If insurance companies roll back and see that they can get away with it, they will,” she said.

Scott said it would be a shame if treatment reverted back to pre-pandemic ways because insurance companies no longer covered telehealth. With many patients finding it increasingly difficult to attend services, no-shows could increase.
Or patients would simply choose not to continue therapy. When it comes to telehealth, she concluded, “This helps people get better faster.”

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