BOSTON (SHNS) – As the pandemic forced the health care industry to quickly react to a surge of COVID-19 cases, telehealth offered a lifeline to people who needed to access health services remotely, a top official at Blue Cross Blue Shield of Massachusetts said during a Tuesday webinar.
“During the height of the pandemic, about 80 to 90 percent of all care was telehealth related,” said Michael Caljouw, vice president for Government and Regulatory Affairs at Blue Cross Blue Shield of Massachusetts. “And it provided a very important life preserver, life raft for folks who were stuck at home, wanted to access services, particularly in the behavioral health area, which we had expected were going to go up and have gone way up in terms of need, but also played a role in terms of addressing other care needs that weren’t being addressed because people weren’t able to see their doctor live.”
Caljouw joined Insurance Commissioner Gary Anderson and Sen. Cindy Friedman for a conversation on what Massachusetts could have done to be better prepared for the COVID-19 crisis. A key takeaway from the moderated event host by The Rappaport Center for Law and Public Policy at Boston College: telehealth allowed hundreds of thousands of appointments with providers despite the emergency circumstances and created a pilot of distanced health care, Anderson said.
“We’ve now got, I mean almost exactly, right, six months of data on what will work, what won’t for the development, for policymakers like the senator to make decisions,” Anderson said referring to Friedman.
One of the top administrators at the Centers for Medicare and Medicaid Services, Seema Verma, said in August that Massachusetts had the highest utilization of telehealth and that nearly 50 percent of the Medicare fee-for-service beneficiaries used telemedicine during the pandemic in the state.
In the Legislature, the House and Senate passed bills that look to make telehealth permanent in the state’s health care landscape as the pandemic forced providers to carefully manage their resources amidst a surge of COVID-19 cases. The two bills entered a conference committee, where lawmakers privately negotiate differences, at the end of July.
While the committee has not held its first formal meeting with all members present, an aide to the House’s lead negotiator Rep. Ronald Mariano said both Mariano and Friedman, the Senate’s lead negotiator, “have been actively discussing the parameters of the conference committee.”
Friedman, Healthcare Financing Committee co-chair, said two pieces came out of the growth of telehealth during the pandemic.
“One was that it allowed health care to continue, which is paramount,” the Arlington Democrat said. “The other piece of it that I think is really important, and unfortunately this is what pandemics tend to do, or crises, is we took a step that some of us have been trying to take for a very long time. And we just did it. We just turned on telehealth.”
The move to expand telehealth, Friedman said, allowed lawmakers and health care leaders alike to look at the system and determine what works, what doesn’t work, and how officials can continue to guide the practice “and yet, control it in a way so that it works for patient care.”
While the use of telehealth increased during the pandemic, Friedman said people are starting to see how the practice may not work for all groups of people. Behavioral telehealth services, for example, may not be the best choice for young children, she said.
“It doesn’t work quite as well. The kids, we need to keep doing telehealth, but we can now see, okay, here’s how telehealth may not work for certain groups,” she said. “And so we’ve now got to focus on making sure that they get their care. So I think that’s been really important. And we need to, like so many of the activities that have taken place over the course of the six months, we need to look at what we’ve learned.”
Caljouw said there was an expectation that seniors “wouldn’t tackle telehealth ably.”
“Generationally, we saw seniors using telehealth … in much higher numbers than sort of the presumption was going into this,” he said. “On the front end, it may not be as appropriate for every child … or behavioral health setting, but it’s a much more adaptable program. And seniors use the technology much faster than we had expected to happen.”
At the federal level, President Donald Trump signed an executive order in early August to expand access to telehealth in rural communities. Gov. Charlie Baker issued an executive order in mid-March instructing commercial insurers to deliver services via telehealth so patients could avoid making trips to medical offices.
“If we do the year over year comparison to our telehealth visits to a year ago, we’re now at about 50 percent growth compared to last year. And now we’re net with in-office visits and telehealth at a higher level year over year to last year at this time,” Caljouw said. “If you add up telehealth plus in-office, we’re at sort of 120 percent of capacity compared to August, September of last year. And some of that might be pent-up demand from folks not getting services before but there was a time when that telehealth, non-telehealth or in-office visit comparison was 80 percent telehealth, 20 percent in-office.”
Now the comparison has flipped, with telehealth visits ranking lower than in-office, Caljouw said.
“People are feeling safe to go back into the doctor. The safety protocols that small offices have put in place or larger systems have put in place have worked,” he said. “And I think folks are starting to feel less afraid to interact with their provider in that way, which is a good thing.”