5 Health Plan Telemedicine CasesPayers continue wrestling with service delivery expenses to the expanded insurance coverage audience, who were previously uninsured or underinsured. Health insurers now meet the needs of these newly-covered individuals and families, including assuring access to specialty care. One strategy insurers employed is the use of telemedicine. Telemedicine expands access to needed care, facilitate better care coordination and help contain costs. A recent report profiles the efforts of five health plans to deploy telemedicine to meet the needs of a growing member base. These initiatives cover a wide range of services and approaches, including increasing access to child psychiatry, connecting members in rural counties to specialists, using electronic referrals to enhance communication between providers, and leveraging telemedicine to better integrate physical and mental health.


In the United States the number of patients per primary care physician is increasing; more providers are preparing to retire while both an aging population and an increase in the number of individuals obtaining coverage under the ACA increase demand.2 Shortages are no longer limited to primary care doctors; by 2020 there will be a deficiency of an estimated 46,100 specialists and surgeons in the United States. This decrease in supply will only exacerbate provider shortages that exist today, especially in rural communities, and contribute to escalating health care costs. In response to these constraints, Safety Net Health Plans have looked to telemedicine as a potential solution.

Telemedicine leverages technology to coordinate care and extends the settings in which care can be delivered. Telemedicine can take place through a video conference, over the phone, or through electronic messaging, including images, test results and other data. Consultations can take place between a doctor and a patient, or between two or more doctors. Telemedicine can help patients who live in areas with few specialists get the care they need more quickly or more conveniently, sparing them a long trip. It can also help specialists with heavy caseloads dispense care more efficiently, providing consults to primary care physicians (PCPs) and providing direct access for patients with more complex needs. This increased coordination not only addresses access problems; it also can help bend the cost curve.

A survey of ACAP-members found that more than half reimbursed for services delivered through telemedicine. However, many plans may be limited in their use of telemedicine, or decline to use it altogether because of state requirements. For example, only twenty states specifically authorize Medicaid managed care organizations’ use of telemedicine.

Because telemedicine has a vast scope, policy makers have taken various approaches when governing the industry including regulating:

  • Patient and provider settings: the patient’s location, or the “originating site,” and/or the location of the provider offering care or consultation, or the “distant site;”
  • Allowable provider types (e.g., psychiatrists)
  • Eligible technology and services (e.g., videoconferencing or remote monitoring)
  • Distance or geography standards (e.g., requiring a patient to live in a rural setting to receive services via telemedicine)
  • Requirements that another certified individual, or telepresenter, be present with a patient during a telemedicine visit
  • State licensure requirements that require providers to be licensed in the state which they are delivering telemedicine services

Despite certain policy hurdles, health plans are using telemedicine to develop new and innovative models for delivering care. Five profiles follow detailing how health plans use telemedicine to increase access, better coordinate care and contain cost.

  1. San Francisco Health Plan (SFHP): An Electronic Referral and Consultation System Addresses Access Problems and Facilitates Care Coordination
  2. Colorado Access (COA): One Plan Builds Its Own Platform to Integrate Physical and Mental Health
  3. Community Health Plan of Washington (CHPW): Coordinators Use Telemedicine as a Vehicle to Integrate Mental and Physical Health
  4. Partnership HealthPlan of California (PHPC): Videoconferencing Pilot Connects Rural Northern Californians to Specialists
  5. Driscoll Health Plan (DHP): Working to Address Child Psychiatric Needs while Navigating Telemedicine Policy

For details on the programs and the lessons learned, download the Report.