Impact of the COVID-19 pandemic on the uptake of telehealth services: A survey of US payers Chris Yost, PharmD1; Michael Sporck, PharmD, MBA1; Derek Louie, PharmD, MS1; Melissa McCart, PharmD, MS1 1 Xcenda, Carrollton, TX, USA
Background Results
• In February 2020, the Centers for Disease Control and Prevention (CDC) issued guidance advising healthcare Payer expansion of covered telehealth services during COVID-19 Figure 4. Percentage of respondents reporting an increase in telehealth Figure 6. Percentage of respondents reporting change in utilization of specified drug categories due to Figure 8. Percentage of respondents who anticipate specified formulary changes due to expansion utilization for specified chronic conditions COVID-19 of telehealth services providers to adopt social distance practices, specifically recommending healthcare facilities offer clinical • 95% of respondents indicated that they expanded the coverage of telehealth services in 1 Add self-injected mediations as a services through virtual means such as telehealth at least 1 line of business (Figure 2) Cardiovascular 59% 33% Behavioral health treatments 21% 26% 54% preferred/co-preferred option • Telehealth services have expanded rapidly and dramatically during the COVID-19 pandemic2 • After the COVID-19 pandemic began, there was a 30% increase in the number of Endocrine 56% Add medications with favorable safety Self-injectable (subcutaneous) 23% • Emergency government action has helped encourage the use of telehealth services by temporarily removing respondents indicating that they covered behavioral health visits via telehealth, a 26% Psychiatry 54% profile as a preferred/co-preferred option 3 treatments compared 5% 18% 26% 51% barriers to accessing telehealth and expanding the scope of covered services increase in the number of respondents covering specialty provider visits via telehealth, Add medications with no laboratory monitoring Respiratory 46% to IV infusion options 18% • Many private payers have followed suit by expanding their coverage of telehealth services4 and a 24% increase in the number of respondents covering substance abuse counseling as a preferred/co-preferred option Prefer IV medications which can safely be via telehealth (Figure 3) Autoimmune 23% Substance use disorder 5% 23% 36% 36% 18% • Although many private payers have aligned with government telehealth service expansion, it is unclear to what administered via home infusion • 70% of respondents stated that some or all of the telehealth services covered under their extent different organizations have expanded their coverage of telehealth services and if these changes will GI conditions 23% Remove physician reported expansion will remain permanent Medications with no 10% remain permanent 3% 21% 49% 28% assessments from PA criteria Neurology 23% laboratory monitoring • 76% of respondents stated that patient copays for telehealth services had been reduced Add medications with patient-reported 3% 10% or eliminated Oncology 23% measures as preferred/co-preferred options Medications with favorable safety 3% 18% 54% 26% Objective • 54% of respondents stated that reimbursement to providers for telehealth services were Nephrology 15% profile compared to other options No changes 51% now equivalent to face-to-face visits Hematology 10% Controlled substance • To evaluate current and future patterns of coverage for telehealth services as a result of the COVID-19 pandemic 13% 31% 38% 18% Q7: Do you anticipate that the expansion of telehealth services may result in any of the following formulary prescribing via telehealth Figure 2. Percentage of respondents expanding telehealth coverage due to COVID-19 by line of business Other 10% management changes? (N=39) 94% 89% Rare Diseases 5% Decreased Don’t know No Change Increased 79% Methods 68% Q3: What chronic disease therapeutic areas have seen a greater increase in the Q5: Please indicate if your organization has seen a change in utilization in any of the following drug categories as a Limitations utilization of telehealth services? (N=39) result of COVID-19. (N=39) • An online survey was fielded during November 2020 to a panel of managed care professionals from Xcenda’s • Survey results were descriptive in nature and based on a small number of respondents Managed Care Network (MCN) Figure 5. Percentage of respondents reporting an increase in telehealth Figure 7. Percentage of respondents reporting change in utilization of sites of care for infusible drugs due to and thus may not be generalizable to all payer organizations or payer types –The MCN is a proprietary research panel, with over 160 healthcare executives, medical and pharmacy utilization for specified acute conditions COVID-19 • Because all respondents voluntarily completed the survey, voluntary response bias may directors, and other experienced individuals in managed care, representing over 275 million covered lives 5% Seasonal infectious disease – 46% exist, and survey results may over-represent respondents with stronger utilization of non-COVID-19 Home infusion 5% 10% 23% 62% • Respondents included in the survey were required to be active formulary decision makers within an organization Commercial Medicare Medicaid Health insurance Did not expand telehealth services that currently covers telehealth services marketplace Other common acute infections 44% Q1: In response to the COVID-19 pandemic, did your organization expand the coverage of telehealth services in any Infectious disease – Physician’s oce 33% 15% 33% 18% Figure 1. Respondent Demographics 38% Conclusions plan or line of business? (N=39) COVID-19-related Stand-alone • A total of 39 advisors from Xcenda’s MCN completed the survey: 49% 15% 23% 13% Acute GI conditions 38% infusion center • In response to the COVID-19 pandemic, payers in this study expanded coverage of Figure 3. Percentage of respondents covering specified telehealth services before and after the COVID-19 telehealth services pandemic began Acute CNS conditions 33% 56% 44% 64% 36% Hospital inpatient 59% 18% 13% 10% • Payers expanded access to a variety of services, beyond COVID-19-related visits, Before COVID-19 After COVID-19 Pharmacy Medical Regional National Acute joint/limb conditions 26% as well as the scope of reimbursed services Hospital outpatient directors directors 69% 72% 59% 10% 26% 5% • Utilization of telehealth services has increased for both chronic and acute conditions plans plans infusion center Other 5% 56% 54% • During the COVID-19 pandemic, there has been an increase in the utilization of certain categories of drugs including self-administered drugs and in-home infusion 42% 39% 41% 38% Q4: What acute disease therapeutic areas have seen a greater increase in the Organization type Decreased Don’t know No Change Increased as a site of care for physician-administered IV drugs 28% utilization of telehealth services? (N=39) 64% 23% 26% 19% Q6: Please indicate if your organization has seen a change in utilization for the following sites of care for infused • Telehealth expansion may change the formulary management philosophy for a 14% products as result of COVID-19. (N=39) portion of payers 23% 6% 6% 3% Drug utilization trends during COVID-19 • Telehealth services will likely remain a prominent mode of providing healthcare in 13% Primary care Behaviorial Acute care Specialty Specific Substance Expanded Other • Respondents indicated that utilization of some categories of Formulary management changes due to telehealth expansion the future provider health visit visit provider therapeutic abuse prescribing medications increased during the COVID-19 pandemic (Figure 6) visit visit area counseling authority • A portion of respondents anticipate formulary changes will occur as a result of their Health plans Integrated delivery networks Pharmacy benefit managers • 54% of respondents reported increased utilization of behavioral organization’s telehealth expansion (Figure 8) Q2: What services were included in your organization’s expansion of telehealth due to the COVID-19 pandemic? health medications, 51% observed an increase in the utilization • 33% of respondents indicated that they anticipate adding self-injectable medications References (before: N=36; after: N=39) of self injectable medications compared to IV infusions, 36% P&T formulary design roles as a preferred/co-preferred option in line with physician-administered infusion products, reported increased utilization of substance abuse disorder 1. Koonin LM, Hoots B, Tsang CA, et al. Trends in the use of telehealth during the emergence of the COVID-19 23% anticipate adding medications with favorable safety profiles as a preferred/co- pandemic—United States, January–March 2020. MMWR Morb Mortal Wkly Rep. 2020;69:1595-1599. medications, and 28% reported an increase in the utilization of Telehealth utilization trends by disease category preferred option, and 18% anticipate adding medications that do not require laboratory 2. Long D. Health care trends and impact of COVID-19. Oral presentation at: AMCP webinar. July 9, 2020. Accessed 64% 46% 33% • 77% of respondents indicated that they had seen an increase in telehealth utilization for medications that do not require laboratory monitoring monitoring as a preferred/co-preferred option March 19, 2021. https://www.amcp.org/Resource-Center/covid-19/health-care-trends-and-impact-covid-19 Voting Medical/clinical Chair/ the treatment of chronic conditions and 67% had seen an increase in utilization for the 3. Health Resources & Services Administration (HRSA). Policy changes during COVID-19. March 9, 2021. Accessed March Site of care utilization trends during COVID-19 • 51% of advisors stated that the expansion of covered telehealth services would not 19, 2021. https://telehealth.hhs.gov/providers/policy-changes-during-the-covid-19-public-health-emergency/ members advisors co-chair treatment of acute conditions change their formulary management decisions • 62% of respondents reported an increase in utilization of home 4. Center for Connected Health Policy. An analysis of private payer telehealth coverage during the COVID-19 pandemic. • Chronic condition categories that were most often reported as having seen an increase in Public Health Institute 2021. Accessed March 19, 2021. https://www.cchpca.org/sites/default/files/2021-01/ infusion as a site of care for infusible medications (Figure 7) Private%20Payer%20Telehealth%20Coverage%20Reportfinal.pdf utilization included cardiovascular (59%), endocrine (56%), and psychiatry (54%) (Figure 4) • Other sites of care that respondents reported as having seen • Acute conditions that were most often reported as having seen an increase in utilization a decrease in utilization include physician offices (33%), stand- included seasonal non-COVID-19 infectious diseases (eg, flu, cold) (46%), other acute alone infusion centers (49%), hospital inpatient (59%), and infections (eg, skin, ear) (44%), and COVID-19 related infections (38%) (Figure 5) hospital outpatient (59%) Presented at 2021 AMCP Virtual Meeting April 12 - 16, 2021
Acknowledgements: Funded by Xcenda. | Please direct questions to: Chris Yost at [email protected]