State’s largest insurer extends full telehealth coverage indefinitely

Blue Cross Blue Shield of Massachusetts said it would continue paying for remote visits at the same rates as in-person visits.

Houston Cofield/NYT

Blue Cross Blue Shield of Massachusetts plans to continue paying for telehealth sessions at the same rate as in-person visits for primary care and chronic illness care. The announcement from the state’s largest insurer comes as doctors brace for cutbacks to reimbursement rates for telehealth because pandemic-era regulations have lapsed.

In 2020, the vast majority of doctors’ visits happened remotely, as the pandemic forced everyone to stay home, and health care providers quickly pivoted to offering care by video and phone. Blue Cross paid for a mere 42,000 telehealth visits in 2019. That number soared to 6.7 million by 2021 and then diminished to 5.4 million in 2022.

This revolution in care was made possible by the waivers of several regulations and practices that had previously been obstacles to the growth of telehealth. Chief among them was the pandemic requirement that insurers reimburse telehealth visits at the same rate as in-person visits.

But now, doctors’ offices are open and the waivers rescinded. New legislation requires insurers to continue paying the same for remote and in-person behavioral health care. But they are free to reinstate reduced payments for telehealth visits in primary care and chronic care.

So far, insurers have held off doing so, but many are expected to start cutting back this year.

Lora Pellegrini, chief executive of the Massachusetts Association of Health Plans, said in a statement that “health plans will make individual determinations” about reimbursement rates. “As care has returned to in-person settings, there now exists an opportunity for telehealth to deliver on its promise of cost-savings for employers and consumers in the Commonwealth,” she said. “To do so, health plans must negotiate appropriate reimbursement rates with providers....”

Point32Health, the state’s second largest insurer, said that starting March 1, it will go back to reimbursing for telehealth at 80 percent of the rate it pays for in-person visits.

“Our top concern is making health care more affordable for members and ensuring reimbursement rates take into account the costs associated with delivering the services,” said Point32Health, the insurance company formed by the merger of Harvard Pilgrim Health Care and Tufts Health Plan, in a statement. “We value telehealth and the crucial access it brings to our members. … There will be no coverage disruption for our members, as we will continue to provide coverage to telehealth services within our provider network, as well as through our telehealth vendors.”

But Michael Caljouw, Blue Cross’s vice president for government and regulatory affairs, said that Blue Cross is concerned about the growing demand for services amid workforce shortages.

“We have examined the health care landscape, including the incredible strain that providers and other clinicians are under currently,” Caljouw said. “We believe telehealth can be an additional means to alleviate that capacity strain and don’t want to disincentivize any set of services.”

The decision to keep paying the full rate for telehealth, he said, “strikes the appropriate balance between acknowledging the challenges that the Massachusetts health care system is facing with the need for sustainable, cost-effective telehealth for the long term.”

The payment isn’t for a quick phone call, but covers interactions that have the same qualities as an office visit, whether by phone or video.

“Telehealth provides the flexibility for a variety of patients who frankly don’t have the ability to take time off from work, or may have trouble with child care,” he said.

Evidence so far shows that the availability of telehealth did not prompt people to see their doctors more often, but rather was a one-for-one substitution, Caljouw said. “We will want to closely monitor the utilization rates in the future so there is no supplemental utilization that way without commensurate value,” he said.

Barbra Rabson, president and CEO of Massachusetts Health Quality Partners, called Blue Cross’s decision “absolutely good news.”

She noted that primary care is “extremely fragile” right now. “This is not a good time to reduce any payment to primary care,” Rabson said.

Her organization, which aims to improve patient care experiences, has been conducting regular surveys of patients and providers about telehealth. Already, she said, providers appear to be pulling back from telehealth in anticipation of payment cutbacks. About 25 percent of patients reported in 2022 that they wanted a telehealth visit but their provider did not offer the option.

Providing full payment for telehealth won’t raise costs overall, Rabson said. Only 7.3 percent of health spending in Massachusetts goes to primary care, “which is completely pathetic,” she said. “If costs are going up in the system, it’s not because you’re seeing your primary care provider.”