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Wellmark to hold provider pay rate for telehealth

Wellmark Blue Cross and Blue Shield announced on Wednesday it would continue reimbursing providers at the same rate for
Wellmark Blue Cross and Blue Shield announced on Wednesday it would continue reimbursing providers at the same rate for virtual health care as in-person care for at least another five months, and would continue if telehealth proves to be effective long term. (Jim Slosiarek/The Gazette)

Iowa’s largest health insurer will pay health care providers for telehealth services at the same rate as in-person services through the end of January.

The use of telehealth rose across the state as an alternative to in-person hospital visits as hospitals worked to conserve personal protective equipment and reduce in-person contact.

Wellmark Blue Cross and Blue Shield announced on Wednesday it would continue reimbursing providers at the same rate for virtual health care as in-person care for at least another five months, and would continue if telehealth proves to be effective long term.

The insurance company began equalizing payments for in-person and virtual care in March, as novel coronavirus mitigation efforts postponed non-essential surgeries and hospitals faced shortages in personal protective equipment.

Before the pandemic, Wellmark reimbursed providers at half the rate of in-person medical visits and 75 percent of in-person behavioral and mental health services, said Scott Sundstrom, vice president of government relations at Wellmark.

But the Des Moines-based insurer leveled the rates to incentivize telehealth as an alternative to in-person care, and Gov. Kim Reynolds soon after directed all insurance companies to do so.

University of Iowa Health Care alone conducted more than 63,000 telehealth visits from March to May, according to UI Vice President for Medical Affairs Brooks Jackson. He said in a news release telemedicine acted as an “important supplement for in-person office visits.”

He added that all 35 adult and 27 pediatric specialties at UI Health Care now have the ability to offer telehealth visits, which saves each patient an average 46 miles round trip.

“The pandemic is not over and the increased demand for telehealth will continue, so we appreciate and recognize the importance of Wellmark continuing to make payments at the same level as in-person visits,” Jackson wrote.

During the extended period of time with equal reimbursement rates, Sundstrom said the insurance company would re-evaluate whether to continue offering those based on data collected on three fronts.

First, the overhead cost of telemedicine, Sundstrom said, may be lower than an in-person visit. For example, less PPE is needed for a tele-visit as the physician and patient aren’t interacting in person.

Second, the insurer wants to determine whether telehealth produces better or equal health outcomes compared to in-person visits.

Telemedicine wasn’t widely used in the state before the pandemic, Sundstrom said, meaning the company had less data on whether telemedicine could be more effective.

“We saw usage really spike during April and May, and it’s starting to go down again,” he said. “It’s higher than it was before the pandemic, but it’s a lot lower than it was during the peak of the pandemic.”

Third, he said Wellmark would research whether telehealth could be a replacement for in-person care.

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“If I have a telehealth visit and I, or other patients, tend to then go in person and see the doctor anyway, that’s not very efficient,” Sundstrom said. “It’s maybe just adding an extra visit, adding utilization and cost.”

Comments: (319) 398-8370; sarah.watson@thegazette.com

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