Last Updated 6/1/2023

Issue: Telehealth or telemedicine is the practice of using audio and video technologies to provide some types of services to patients from a distance. While these two terms sometimes are used to mean the same thing, they refer to different services. Telemedicine refers to remote clinical services that licensed providers perform. Telehealth encompasses a broader set of activities, including: 1) educational webinars; 2) licensing or credentialing services; or 3) patient care meetings. Telehealth and telemedicine have several advantages over in-person services, including: 1) lower costs; 2) increased access; and 3) infection control.

According to the Telehealth Resource Center, there are areas of applications for telehealth:

• Live videoconferencing (synchronous): This is a live, two-way interaction between a person and a provider using audiovisual telecommunication technology.
• Store-and-forward (asynchronous): This is a transmission of recorded health history to a practitioner, usually a specialist. The practitioner then uses this information to evaluate the case outside of real time.
• Remote patient monitoring (RPM): Caregivers collect data to monitor patients. This data could include blood pressure and blood sugar levels.
• Mobile health (mHealth): Telehealth services are delivered via mobile devices like smartphones or tablets. Often, an app is used.

Background: Telemedicine started in the 1940s. Radiology images were sent 24 miles between two townships via telephone line in Pennsylvania. In the 1960s and ’70s, several government agencies invested in research on telemedicine. These agencies included: 1) the National Aeronautics and Space Administration (NASA); 2) the U.S. Department of Defense (DOD); and 3) the U.S. Department of Health and Human Services (HHS). One of the most successful of these projects was a partnership between the Indian Health Service (IHS) and NASA. The project was called Space Technology Applied to Rural Papago Advanced Health Care (STARPAHC). This project provided access to medical care to both Native Americans on the Papago Reservation in Arizona and to astronauts in orbit.

Telemedicine services have existed for decades. However, widespread adoption has been slow. Nonetheless, these services are gaining popularity for two reasons: 1) the expansion of easy-to-use video conferencing applications; and 2) the COVID-19 pandemic of 2020.

Prior to the COVID-19 outbreak, both government and private payers were reluctant to implement telemedicine programs. They were concerned that the ease of access would drive usage of telemedicine programs, which would lead to increased costs. For years, reimbursement for telemedicine was often less than half the amount of a standard in-person visit. However, the first quarter of 2020 saw both private and public payers reimbursement rates increase to match those of in-person provider visits. As the pandemic begins to subside, patients and providers have expressed interest in maintaining the increased availability of telehealth services, with surveys showing that nearly half of respondents have attended a telehealth appointment within the last year.

Status: During the COVID-19 pandemic, many states expanded coverage and availability of telehealth services to: 1) limit spread of the disease; and 2) expand access to health care. In March 2020, Medicare began allowing all enrollees to use telemedicine. Previously, this option was available only to those in remote areas or for short, specific visits. Additionally, physicians were granted reciprocity to provide telemedicine services to Medicare patients across state lines. Some states, including Missouri and Pennsylvania, also allowed physicians licensed outside the state to provide telemedicine care more easily. Further, some states, including Idaho and Colorado, allowed providers to use, in certain circumstances, technologies not compliant with the federal Health Insurance Portability Act of 1996 (HIPAA). Many states required insurers to reimburse telehealth services at the same rate as in-person services. Several states have also limited or reduced to zero the amount that state-regulated insurers may charge in consumer cost sharing for telehealth services during the pandemic.

Health care systems also worked to make access to telemedicine services easier by increasing the availability of physicians and waiving copays for the duration of the pandemic. The NAIC tracked state actions in this area and other pandemic-related issues in the Coronavirus Resource Center.

The Health Insurance and Managed Care (B) Committee monitors developments in the health insurance industry. This includes telehealth services. At the 2021 Spring National Meeting, the Health Innovations (B) Working Group heard presentations from the Washington State Office of the Insurance Commissioner and industry stakeholders on state regulations related to telehealth. The NAIC and state insurance regulators continue to closely observe developments in this area in order to: 1) protect consumers; and 2) promote access to care.

The Special (EX) Committee on Race and Insurance charged the Health Innovations (B) Working Group’s with evaluating mechanisms to reduce disparities through a few different means, including telehealth services and alternative payment models. The Working Group summarized the research from the Center for Insurance Policy and Research (CIPR) in the memorandum. Key findings include that telehealth has great potential to bridge the gap in access to care by connecting isolated people with culturally competent health practitioners while reducing the need for transportation to receive such care. To help ensure that the greater use of telehealth does not exacerbate disparities, state insurance regulators should be aware of the limitations and consider steps to increase digital literacy and access to the technology patients need to support the delivery of telehealth services, such as hardware, software, and broadband access.