Technology has impacted everything we do, and sometimes we take it for granted without recognizing how powerful and beneficial advancements can be. Some of the greatest advances have been in healthcare. With the help of mobile devices, telehealth has been able to provide healthier outcomes at lower costs while increasing patient access.

Telehealth is a convenient method to access care remotely and is becoming a growing trend across all generations – more pointedly the senior population. The younger seniors are increasingly more accustomed to utilizing technology and once adopted; it becomes an integral part of their lives, according to an article published in the U.S. National Library of Medicine National Institutes of Health. The Centers for Medicare & Medicaid Services (CMS) has also found data that demonstrates significant growth in telehealth utilization among beneficiaries 85 years and older, per a recent report sent to Congress.

Priority Health: Telehealth in Action

At Priority Health, the provider-sponsored health plan of Spectrum Health, in Grand Rapids, Michigan, Medicare members have benefited from telehealth by accessing care through video visits since the program launched in 2014. Michigan is one of the top 10 states with the highest telehealth utilization in the country. “We are proud to be able to connect senior members with providers through our virtual care platform 24/7. It’s convenient, cost-effective, and a growing trend in today’s healthcare landscape,” said James Forshee, MD, chief medical officer for Priority Health.

CMS’ Telehealth Expansion Proposal

While telehealth isn’t necessarily a new benefit in Medicare, the goal to have it more widely utilized is part of the reason CMS proposed a rule to expand telehealth access for seniors in the Medicare Advantage (MA) and Part D programs. The proposed expansion, slated for 2020, is two-fold as it will not only broaden access to care, but it will also be part of the basic benefits category. Per CMS’ press release, this proposal will allow MA plans to have broader flexibility than is currently available in how they pay for coverage of telehealth benefits to meet the needs of their enrollees.

According to CMS’ fact sheet, the Original Medicare telehealth benefit is narrowly defined and includes restrictions on where beneficiaries receiving care via telehealth can be located. The proposal would give beneficiaries the ability to receive telehealth benefits from the convenience of their homes, regardless if they live in rural or urban areas. “This proposed expansion is a great idea for all – not just those who live far from their provider,” said Michelle Coberly, manager, Medicare compliance, Priority Health. “This will make it easier for MA members to get the immediate care they need. In turn this ensures the member gets the right care at the right time.”

The inclusion of telehealth services in the basic benefits category means this will change the way provider payments are made. CMS will now pay doctors for telehealth visits and communication with patients. With this change, CMS expects that more MA plans will include telehealth services in the basic benefits category and increase their support of these services in subsequent years. CMS’ proposal will be open for feedback by payers’ compliance officers until December 31, 2018. By April 2019, when CMS publishes its final Call Letter, we’ll know if this policy will be in place for 2020.  

Priority Advantage Incorporates Telehealth with its Clients

Priority Advantage provides business process outsourced solutions to help organizations launch and achieve high performance in Medicare Advantage, and supports existing plans in specific areas that need improvement. Priority Advantage has extensive experience with designing products and benefits that meet the needs of its clients’ members, while meeting the overall strategy of the plan.

As healthcare organizations look to enter the MA market, it’s crucial to design plan benefits that utilize technologies in care delivery, like telehealth, that increase quality and access to care. The product design team at Priority Advantage is eager to build benefits that include telehealth for its clients. The team recognizes that telehealth is a game changer for how health services are delivered. Beyond providing virtual access to care, when fully embraced, telehealth has a significant role in remote monitoring of patients with chronic conditions, which will ultimately mean less frequent acute care and ER visits. Whether your organization is interested in entering the MA market, needs support with optimizing performance, or you have questions about improving membership growth through product design, please leave a contact us at

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