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Telehealth has been a saving grace during the pandemic. Will insurers let it continue?

It’s the multi-million-dollar question in upcoming contract negotiations. Modern Healthcare’s March 13 story reports on the fate of telehealth as we approach future hospital-insurer negotiations.

As a post-pandemic future takes shape, many of us are anxiously waiting to see how telehealth will be treated in upcoming contract hospital-insurer negotiations.

Some analysts predict that hospitals are going to ask for telehealth reimbursement rates that are similar to those for in-person visits. This strikes us as reasonable, given that the pandemic has revealed just how effective remote care can be due to the expanded access and flexibility it offers patients and providers. And while that’s great for patients, it’s causing concern among insurers, given they will be on the hook to pay for the care. As we covered back in November, they have a proven track record of pushing back against telehealth coverage and claims.

Modern Healthcare suggests looking at how the hospital-insurer relationships played out during the COVID-19 crisis so far for clues about the future fate of telehealth. So we reviewed UnitedHealthcare’s recent public interactions with providers. (Uh oh!) In the last few months, the insurer has forced hospitals to choose between accepting drastic reimbursement rate cuts or being booted out of United’s network. Here’s the evidence:

• In January, United cut thousands of emergency room doctors from its 2021 network because it couldn’t reach an agreement with Envision Healthcare.
• Another move cut a critical NYC safety-net health system from the United network, just as COVID-19 cases hit record highs.
• Right before that, United severed ties with the only hospital in Gaston County, leaving about 11,000 patients to contend with out-of-network bills.

The tally? It appears United has more providers out of network right now (during the COVID-19 pandemic) than it has in the past five years. Providers are on their heels.

So, yes. We’re worried. Will providers even be able to prioritize telehealth the way they want to when it seems so hard to get reimbursement for traditional, in-person visits? In our experience, hospitals usually like to partner with insurers, but insurers’ harsh tactics in negotiations can make it difficult. And with insurers likely looking to stave off telehealth reimbursement bills they’ll be (reasonably) expected to pay, hospitals will need to be prepared to play hardball to negotiate for what they need—telehealth parity included.

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