Association between state payment parity policies and telehealth usage at community health centers during COVID-19

Abstract

Objective We study the association between payment parity policies and telehealth utilization at community health centers (CHCs) before, during, and after the onset of the pandemic. Materials and Methods We use aggregated, de-identified data from FAIR Health for privately insured patients at CHC sites. Descriptive statistics and time trends are calculated. Logistic regression models were used to quantify the factors associated with telehealth utilization for each of our time periods: 1) pre-pandemic (March-June 2019), 2) immediate pandemic response (March-June 2020), and 3) sustained pandemic response (March-June 2021). Results Telehealth usage rates at CHC sites surged to approximately 61% in April 2020. By April 2021, only 29% of CHC sites in states without payment parity policies used telehealth versus 42% in states without. Controlling for other characteristics, we find that CHC sites in states with payment parity were more likely to utilize telehealth one year after the onset of the pandemic (OR:1.740, p<0.001) than states without, but did not find this association in 2019 or 2020. Discussion The public health emergency drove widespread use of telehealth, making the virtual care environment inherently different in 2021 than in 2019. Due to the unique fiscal constraints facing CHCs, the financial sustainability of telehealth may be highly relevant to the relationship between telehealth utilization and payment parity we find in this paper. Conclusion Supportive payment policy and continued investments in broadband availability in rural and undeserved communities should enable CHCs to offer telehealth services to populations in these areas.

The Impact of Telemedicine Parity Requirements on Telehealth Utilization in the United States During the COVID-19 Pandemic

“…Payment parity, the independent variable of interest, was measured as whether the state implemented payment parity laws for private payers and during the pandemic. We adopted the list by Erikson et al6 on states with parity payment. As of March 15, 2021, a total of 24 states required private payers' reimbursement parity between telemedicine and in-person visits ( parity states ), Arizona, Arkansas, California, Colorado, Connecticut, Delaware, Georgia, Hawaii, Illinois, Iowa, Kentucky, Maine, Massachusetts, Minnesota, Missouri, Montana, New Hampshire, New Jersey, New Mexico, Rhode Island, Tennessee, Vermont, Virginia, and Washington, while 22 states did not require ( nonparity states ), Alabama, Alaska, District of Columbia, Florida, Idaho, Indiana, Kansas, Louisiana, Michigan, Mississippi, New York, North Carolina, North Dakota, Ohio, Pennsylvania, South Carolina, South Dakota, Texas, Utah, West Virginia, Wisconsin, and Wyoming 6,29.…”

“…Previous studies showed discrepancies in findings on the association between the state's telehealth payment parity laws and telehealth utilization, and dearth of differential impact studies by subgroups 6,20,21,25–27. State's telehealth parity legislation during 2010-2015 was associated with approximately a 30% increase in telehealth visit 20.…”

“…22 Previous studies showed discrepancies in findings on the association between the state's telehealth payment parity laws and telehealth utilization, and dearth of differential impact studies by subgroups. 6,20,21,[25][26][27] State's telehealth parity legislation during 2010-2015 was associated with approximately a 30% increase in telehealth visit. 20 The growth rate of telemedicine encounters among Medicare beneficiaries was higher in states with telemedicine parity legislations on Medicaid and private payers.…”

“…For example, telehealth in surveys is often referred to as telemedicine 4. During the first year of the pandemic from June to November 2020, 30.2% of weekly health center visits occurred via telehealth,5 while telehealth visits represented an extremely small portion of all health center visits before the pandemic 6. In 2021, 23.1% of US adults used telehealth services including video or phone in the previous 4 weeks 7…”

Evolving teledermatology policy and reimbursement landscape in the United States

“…16 , 34 It is also important to consider that payment parity may be salient to maintain access to telehealth services, 55 especially in under-resourced areas and small practices that may not have the financial means to offer telehealth services otherwise. 16 , 60 The discussion on payment parity has prompted consideration of alternative payment models for the use of telehealth services, including emergence of virtual-first health plans among private payers, 61 replacement of payment parity with payment equity, 55 and reimbursement through bundled and value-based payment models. 1 , 55 However, these alternative payment models shift the burden of identifying the most cost-effective uses on providers.…”