Physicians and nurse practitioners will conduct tele-consultations for high-risk pregnancies, strokes, and mental health, with an emphasis on rural areas and small towns.
BlueCross Blue Shield of South Carolina and BlueChoice HealthPlan of South Carolina will use telemedicine to increase access to some specialty services for its members in rural areas.
In mid-August, the insurer announced it will cover consultations for high-risk pregnancies, strokes, and mental health. An unspecified number of specialty providers within each network will be available for telemedicine consultations to any traditional network provider in the state.
"Our intent is to improve access for our members in rural areas and small towns to specialty care and mental health providers, who tend to be in the state's metropolitan areas," said Laura Long, MD, chief medical officer and vice president for BlueCross BlueShield of South Carolina. "We also expect this to increase cost efficiency, reduce transportation barriers, improve quality of care and communication among providers and our members, and in some cases to save lives."
Telemedicine consultations for stroke, commonly referred to as telestroke, have grown to be a covered service. Many states' Medicaid programs, including South Carolina's, already cover telestroke care. "It's a pretty common starting point," says Gary Capistrant, senior director of public policy for the American Telemedicine Association. "Stroke diagnosis is a very common covered situation. High-risk pregnancies are not as common, but are increasingly being looked at."
South Carolina's Medicaid program also already covers some mental health services. "That's a big area for growth in telehealth," says Capistrant. What's unique about South Carolina's Medicaid rules is that the telemedicine visits are covered with a licensed physician and/or nurse practitioner. It is more common for states to limit the telemedicine visit to be handled by a physician only.
South Carolina's telemedicine network for mental health is also well established. The University of South Carolina School of Medicine's partnership with the state's mental health department has helped build a network of 18 emergency departments that use telemedicine for its patients' mental health needs.
The range of covered mental health services through South Carolina's Medicaid program include office or outpatient visits, pharmacologic management, psychiatric diagnostic interview exam, and other diagnostic exams.
Capistrant says a major reason for the growth in mental telehealth services is that the visits are less intimidating for patients. "The person is able to open up a little bit more," he says. "If you have severe depression, you're not likely to put up the shades in your house, much less go to a mental health provider."
State Medicaid programs, in general, have been quicker to cover telemedicine services than commercial payers. In fact, 39 states offer some mental health coverage using telemedicine through Medicaid. By contrast, 19 states require commercial health insurers to do the same.
South Carolina's legislature was considering a bill this year that would have required commercial payers to reimburse for telemedicine services. A Senate health committee approved the proposal, which would have also set up a Telemedicine Advisory Council, but the bill lost support in the state House.
Using shared, secure video connections to pair patient and specialist has been seen as a pathway to help residents in rural areas gain greater access to healthcare, but reimbursement remains a big challenge, says Jee-Young Kim, a healthcare attorney in the California offices of Philadelphia–based law firm Pepper Hamilton LLP.
"One of the big challenges is how are you going to get paid for doing it," says Kim. "There seems to be a trend among states to leave a certain amount of discussion and decision-making up to the market."
Besides BlueCross BlueShield of South Carolina, UnitedHealth and Carolina Care Plan also cover some telemedicine claims in the state. And though South Carolina's telemedicine coverage law didn't make it into statute this year, Capistrant says support for telemedicine is building among states.
"There is a lot of state activity, state interest" in telemedicine, he says. "This was the biggest year for bills introduced, bills being approved. There's clearly momentum; we expect a bigger year for 2014."
Jacqueline Fellows is a contributing writer at HealthLeaders Media.