Our options for online care to patients are rapidly evolving. We announced changes to our telemedicine services on Jan. 1. On the same day, virtual care became a new benefit category. Within the health care industry, the meaning of other terms, such as “telehealth,” seem to change day-to-day. We don’t blame you if you’re confused.
As we continue to improve and expand these new ways of serving our members, we thought you’d like a quick reminder of key similarities and differences among “virtual care,” “telemedicine,” and “telehealth” within our system.
Virtual care is a new category of coverage, which is specific to most of our members seeking care without a face-to-face visit. A member may access care from his or her home, or from an outside site, such as one of our facilities. While video and telephone visits are covered, the interaction doesn’t need to happen in real time. For example, a patient may use our secure messaging service to ask a question of her care team, or a patient could fill out an online questionnaire for certain clinical conditions and have advice and treatment provided within a few hours.
Telemedicine refers to the new Washington state law, SB5175, which defines reimbursable types of clinical care which do not require a face-to-face visit. For 2017, the originating and receiving site must both be clinical facilities. In 2018, the law will change to include allowing “home” as an originating site, meaning patients can initiate these visits without needing to be in a clinical facility. Telemedicine supports both real-time video and “store and forward” technology that permits patients and providers to communicate, but not in real time. Telephone, e-mail, and facsimile interactions are specifically excluded from telemedicine rules.
Telehealth refers to the Medicare definition for clinical care provided without a face-to-face visit. It is defined rigorously under Medicare rules, and originating sites must meet Centers for Medicare & Medicaid Services (CMS) criteria as a rural Health Professional Shortage Areas (HPSA) or be in a county outside of a metropolitan statistical area (MSA). (A metropolitan statistical area is a geographical region with a relatively high population density at its core and close economic ties throughout the area; Seattle-Tacoma-Bellevue is an example.) In addition, the technology is limited to real time video, with the exception of store-and-forward technology, which is allowed only in Alaska and Hawaii under CMS rules.
We’re expecting more changes ahead for our online care options. In 2017, for example, we plan to expand our virtual care capabilities to include a video component. Watch Producer Pulse for more news on this fast-moving set of services.