Telehealth is growing, but Medicare has problems

Cost pressures may increase as Medicare’s hospital insurance trust fund runs low, but the reliance on telehealth that the pandemic has prompted is likely to continue, particularly for mental health services.

In the first half of 2020, the coronavirus forced the healthcare system to transform in a dramatic way that continues today. These changes should remain in place through the first part of 2022, if not throughout the year and beyond.

In interviews with Managed Health Framework®, leaders and experts have predicted that the US healthcare system will continue to add more telehealth to the delivery system, especially for those who need treatment for mental health and addictions. By the end of 2021, this form of care delivery was becoming so popular that insurers were offering telehealth as the first virtual product.

Moreover, according to experts, the healthcare system will continue to focus on the never-ending battle to control costs.

Growing pressure for cost control

This year and next, two forces will come into play that will increase the focus on the need to control health care costs, predicts David Muhlestein, Ph.D., JD, chief strategy and research director for the consulting firm Leavitt Partners. One is the perilous state of the Medicare trust fund, which will be depleted unless Congress changes how the program is paid, the amounts paid, or a combination of the two, according to Muhlestein.

The other is the pressure of health care costs on health plans and employers as the country emerges from the acute phase of the fight against the COVID-19 pandemic and heads towards what appears to be a respiratory illness. endemic.

“In 2022, cost pressures will start to return,” says Muhlestein.

Estimates vary. Medicare’s hospital insurance trust fund is expected to run out in about three to six years, Muhlestein notes: “Nobody knows exactly when that will happen, but it’s definitely on the horizon.”

Given that the Medicare program covered approximately $830 billion in healthcare spending in 2020, or about a quarter of total healthcare spending in the United States, the financial health of the trust fund should be one of the most discussed topics. more urgent in Washington. But politics and this year’s midterm elections will likely postpone any such serious consideration of the issue until later this year or early next year, according to Muhlestein.

“There needs to be a conversation about how to approach the Medicare trust fund,” he says, “but I guess the election will distract Congress for the next year.”

Muhlestein sees an “either” scenario for Medicare: substantial changes to the program or drastic reductions in payments. “It would be incredibly disruptive for doctors, hospitals, health plans, and anyone who has Medicare or Medicare Advantage or is in a managed Medicaid plan because they would all be affected by these changes,” he points out.

Around the same time, the entire US healthcare system could enter what Muhlestein considers a post-acute period of COVID-19. Providers and payers will have to adapt and perhaps manage costs without the significant levels of funding that the federal government has invested to strengthen the healthcare system at the height of the pandemic. Another factor may be an increase in the use of health services, as people who have refrained from seeking care begin to need it, perhaps when their illness is at a more serious stage.

Healthcare providers will need to be more flexible than they have been in the past, predicts Muhlestein. “For a long time, the health system has relied on building capacity around well-reimbursed procedures,” he notes. Space and resources were dedicated to a single purpose. Now and in the immediate future, they will need to be more nimble, reallocating space and resources from one type to another.

“The analogy I use is a hotel ballroom, which can handle a large conference in one room or…provide space for a luncheon or a small wedding,” Muhlestein continues. “Anyway, the space can be rearranged very quickly to meet certain needs.”

If there are only a few cases of COVID-19 in a community, some rooms — in fact, entire facilities — may not be needed. But if severe cases spike, those rooms or facilities, and the doctors and other medical professionals needed to staff them, could be used quickly, he notes.

More virtual mental health care

The toll of the pandemic on people’s mental health is well documented. Isolation has increased. The stress of unemployment has affected millions of workers who have been made redundant. Now labor shortages are affecting those who have kept their jobs. The research results showed that the prevalence of depression has increased.

“The pandemic has elevated mental health to an area of ​​focus for all stakeholders, but especially for employers and all shoppers in general,” said Michael Thompson, President and CEO of the National Alliance of Healthcare Purchaser Coalitions.

Employers want to see changes, such as greater integration of mental health across the spectrum of health care services, including primary care, Thompson says.
Doctors, hospitals and health systems need to demonstrate with data that they are doing more to diagnose mental health problems earlier and to assess patients’ progress during treatment, he says.

But Thompson sees a silver lining in the pandemic: greater access to telehealth, especially for mental and behavioral health services. According to him, telehealth can help fill the void in underserved areas. “For too long,” he says, “employers and other buyers have tolerated unequal access to mental health services.”

In a survey of 142 employers that Thompson’s organization conducted last year, nearly all (92%) of respondents said that access to care for mental health issues and substance use disorders substances would be a priority over the next two years. Telehealth has become one of the main sources of access.

“Telemedicine and telebehavioral health care are here to stay,” says Thompson. “You can’t put that toothpaste back in the tube because it’s more convenient and safer than conventional face-to-face counseling. Also, in many ways, efficiency is higher, in part because it embeds measurement during treatment into the process of care.

Plus, he continues, telehealth has enabled more mental health providers to provide care than ever before, a problem policymakers had struggled to address before the pandemic.

For health insurers, the pandemic has demonstrated the benefits of delivering care via telehealth. Witness the growing number of health insurers that have adopted what they call virtual first aid, in which doctors and other providers meet with patients first and almost exclusively via telehealth.

Joseph Burns is a freelance journalist in Cape Cod, Massachusetts, who writes about health care.


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