Highmark senior medical director talks telemedicine 

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The pandemic had a massive impact on the health care industry’s relationship with telemedicine.  

Where it was once reserved for patients with limited mobility or in rural regions with limited medical services, providers and payers had to quickly expand their telemedicine offerings during quarantine. 

In the early months of quarantine, providers rolled out telemedicine to most patients and expanded the specialty care they could offer virtually as third-party payers upped the reimbursements they offered for telemedicine. 

Highmark Blue Shield’s senior medical director, Dr. Tim Law, spoke to the Journal about how the pandemic impacted Highmark as a payer and what the telemedicine space looks like for payers today. 

CPBJ: How would you describe Highmark’s relationship with telemedicine as a payer, prior to the pandemic? 

Law: Highmark has recognized the value of telemedicine years before the pandemic. Highmark was an early adopter of telemedicine, offering on demand VUC (virtual urgent care) in partnership with Amwell, Doctor on Demand, and Teladoc prior to the pandemic. 

Behavioral health was also offered on the Amwell platform as far back as 2016. Highmark Health was willing to check eligibility and even pay claims on the vendor platforms for Highmark members to receive virtual health services.  

This was an early venture across the industry as many payers did not adopt or make room for telemedicine other than as footnote prior to the pandemic. 

CPBJ: The pandemic did a lot to change how telemedicine was provided. Particularly thanks to rule changes the Centers for Medicare and Medicaid services made to Medicare reimbursements. What did that quick switch over to telemedicine during the months of quarantine look like for a payer like Highmark? 

Law: Highmark immediately stood up an executive level COVID task force for telemedicine to review all the codes available for telemedicine.  

We included providers from across Pennsylvania, West Virginia and Delaware. This code list was adjusted to match the rule changes offered by the Centers for Medicare and Medicaid services. 

 To ensure our members were able to access care in the right setting, at the right time during the COVID-19 outbreak, Highmark was committed to assisting providers to ensure that members had continued access to quality health care despite such challenging circumstances.  

During the early part of the pandemic, we were able to ramp up our telemedicine services so quickly. Overall, by the end of 2020 we saw an increase in utilization of telehealth services by more than 3,400 percent over 2019 and more than 3.4 million telehealth services were accessed by our members. 

CPBJ: How has the company’s relationship with telemedicine services changed in the last two years? 

Law: In the past few years Highmark Health’s strategy shifted. Rising care costs and changing consumer preferences mean that the need for an evolved approach for virtual care delivery across the industry has never been more pressing.  

Recent trends have made virtual health an essential approach to serve our members. COVID most likely had a part in that towards providing a more robust virtual care strategy.  

In 2021 we signed the enterprise agreement with Amwell, we now offer a white-labeled virtual health platform offered exclusively to our members for virtual urgent care visits and behavioral health and plan to add other multispecialty practices. 

Highmark will continue to reimburse providers for virtual visits at parity if the services meet certain criteria.  

CPBJ: Have patient expectations regarding telemedicine changed because of the pandemic? 

Law: Yes, patients have a new sense of comfort with technology as a result of the pandemic.  

They expect a seamless, user-friendly process that will accommodate their needs.  

Highmark’s data also showed that women were more likely to utilize telehealth, and that members aged 30-39 were the most likely to access telehealth services, with 350 per 1,000 members in this age group utilizing telehealth services.  

We also saw the largest number of telehealth claims among members aged 19 or younger. This shows that children and teens are getting regular care during the pandemic, which is really important for their growth and health.  

Our members have used telemedicine services for conditions such as depression, anxiety, flu, pink eye, rashes, strep throat and sinus infections through board-certified doctors 24 hours a day via phone, tablet or computer. The important thing is that our members are able to get the care they need, whether it is in person or virtually. 

CPBJ: What did this shift mean for Highmark’s online offerings? Did you see any change among your telemedicine vendors? 

Law: Yes, there was a drastic increased utilization of virtual health visits during the pandemic.  

In FY 2019 there were 95K virtual health visits and in FY 2020 there were over 3.5M visits to include both vendors and providers.  

In 2021, we have seen a larger increase in vendor virtual health usage and more people going back to their physician in person.  

We have kept all online offerings in place to include vendor and opened up our whole code set availability to telemedicine. That is to say, we have no list of what is available by way of telemedicine. 

If the provider can perform the basic functions of the exam and document that as per normal means they can submit the code for use as telemedicine. This allows out physicians to participate as much or as little as they wish in the virtual health platform. 

CPBJ: How does Highmark and Penn State Health’s strategic partnership fit into this? 

Law: Penn State Health is a valued partner to our overall care strategy. We utilized input from across their system to help hone our strategy during the pandemic and beyond.  

With the large majority of patients seeking care with primary care doctors, even or telemedicine that meant most of the care was still occurring at the local level.  

As a result, Highmark paid local doctors nearly $300 million for telehealth services in 2020, an increase of more than 8,000 percent over 2019.