Blue Cross NC Continues Telehealth Payment Parity—Will and Should Others Follow?

The question all payers must decide is the role that member need will continue to play as the cost-benefit of telehealth parity is weighed for post-pandemic operations.

Blue Cross and Blue Shield of North Carolina (Blue Cross NC) will continue payment parity for telehealth services through September 2022. The policy includes physician video and phone visits. It applies to commercial, Medicare Advantage (MA), and State Health Plan members as well as Federal Employee Program members who are covered "until further notice."

Via company press release, Blue Cross NC CMO Roberta Capp, MD, commented: "As we have seen throughout the COVID-19 pandemic, patients and physicians have relied on telehealth. Blue Cross NC has covered telehealth at parity with in-person visits since the start of the pandemic in March 2020. Extending this policy helps our members access the care they need, when they need it."

The question all payers must decide, however, is the role member need will continue to play as the cost-benefit of telehealth parity is weighed for post-pandemic operations.

Two types of parity

There are two types of telehealth parity: coverage (or "service") and payment, and they apply to video and/or audio service delivery. The Center for Connected Health Policy (CCHP) describes service parity as that which "requires the same services be covered via telehealth as would be covered if delivered in-person … [but] does not guarantee the same rate of payment." Payment parity, conversely, "is a requirement for the same payment rate or amount to be reimbursed via telehealth as would be if it had been delivered in-person."

The CCHP tracks telehealth parity policy, including state laws affecting private payers. As of March 2022, only Florida, Kansas, and Louisiana have passed payment parity laws with many more debating the matter. Even those states that have passed some kind of payment parity legislation don’t necessarily prohibit it. Florida allows telehealth providers to initiate reimbursement differences. Kansas law states that stakeholders, including payers, may establish equivalent payments, while Louisiana allows telehealth reimbursement at 75% of an in-person office visit. 

Continuing payment parity

There are multiple arguments against and for payment parity. In October 2021, Health Affairs examined and refuted the four most common oppositions: that telehealth service delivery is easier and less expensive for providers, has less value, and may drive overutilization. While article author and physician researcher Chad Ellimoottil, MD, notes that "there are several reasonable arguments against payment parity for telehealth," he refutes claims that "mode of delivery" should not be a deciding factor when assessing "the amount of clinical effort" and making "a blanket distinction between high- and low-value care." Ellimoottil adds that

"Policies that prematurely reduce or eliminate payments for telehealth, including audio-only telehealth, will only diminish its use and its potential," notes Ellimoottil. Citing data from another Blues plan (BCBS of Michigan), Ellimoottil adds that "there is little compelling evidence to suggest that continuing payment parity following the pandemic's end will lead to runaway health care spending"—further noting that '[w]hile in theory it may cost less for clinicians to deliver telehealth compared to in-person care, in reality, telehealth does not always reduce practice expenses."

Beyond a crisis response

Ellimoottil recommends that "organizations should temporarily continue payment parity for video and audio-only telehealth after the public health emergency to allow telehealth to flourish outside of the pandemic." He adds that research and data should prove whether "investment in telehealth improves care for beneficiaries and whether or not payment rates are aligned with the costs of delivering telehealth."

In its press release, Blue Cross NC notes that it "will continue to monitor trends going forward," citing 2020 data that 92% of telehealth visits were for primary or mental healthcare.

Regardless of where payers and other stakeholders fall when the public health emergency officially ends, there is a broader question: Why parity—from mental health to telehealth—should function as a crisis response versus a permanent approach to the industry's delivery system challenges?