The COVID-19 pandemic has forced the nation to figure out something it's tried to do for years: increase access to telehealth.
That’s true across the nation and in rural Western states like Idaho.
"We've done 10 years of telehealth adoption in three months," says Dave Jeppeson, director of the Idaho Department of Health and Welfare.
According to Jeppeson’s data, the pandemic has led to a nearly 4,000% increase in Idaho's Medicaid telehealth claims.
"March, April and May of 2019, across all of Medicaid, we had about 3,000 telehealth visits that took place," Jeppeson says. "And for that same time period here of 2020 ... we had 117,500 telehealth claims."
To allow that expansion, federal and state governments temporarily rolled back dozens of regulations. But now that so many people use telehealth, lawmakers don't want to go back to how it was before.
In Idaho, Gov. Brad Little recently signed an executive order that makes his telehealth changes permanent.
"This step should help preserve these health care advances long after COVID-19," he said about the order.
That means Idahoans will be able to keep using phones and non-HIPAA-compliant platforms, like Zoom, to talk with healthcare professionals.
Members of Congress on both sides of the aisle want to maintain telehealth access, too.
Tennessee’s Sen. Lamar Alexander, a Republican, recommended during a Senate committee hearing “that of the 31 federal policy changes that we've had, which have helped cause this explosion of telehealth, that at least two be made permanent.”
His suggested changes include having Medicare and Medicaid cover more telehealth services and cover people in more areas. Before, only people in specific rural locations could get telehealth covered, and even then only certain types of treatment.
Now, telehealth helps Medicaid patients across the nation with everything from physical therapy to counseling.
And telehealth coverage could mean the difference between life and death, like when it comes to addiction challenges in far-flung areas. Or with a stigma around seeking mental health help. Some don't want to come into an office right away, and suicide rates are higher in our region than any other.
But private insurance companies have to help, too. Historically, they haven't reimbursed for a range of telehealth services that studies have shown can be safely provided over video or phone.
"Telehealth has always been a unique challenge for the provision of health care," says John Worley, the vice president for provider network management for Blue Cross of Idaho. "It provides great options and great opportunities for people. But it also raises a number of questions about quality of care, about access, about connectivity."
Still, the company committed to covering more telehealth services to keep patients safe during the pandemic. Other insurers across the region did the same, but they haven't committed to it indefinitely.
As of late June, Aetna and Anthem's end dates for expanded coverage were August 4 and September 30, respectively. Many others are similar.
Blue Cross of Idaho's expanded telehealth coverage lapses at the end of the year, but Worley says some form of it will be provided over the long term because the company believes it minimizes costs and allows more patient access to providers.
That doesn’t mean his company will keep paying providers the same for video visits as for office visits, though.
"We want to evaluate it, look at the market, try to determine if people feel like they're getting the quality of care that they need, try and determine how many people are using it, and try and determine what is an appropriate level of payment," Worley says.
How much insurance companies reimburse for telehealth services could determine which providers keep offering telehealth and who can afford to use it.
Joseph Kvedar, president of the American Telemedicine Association and a professor at Harvard Medical School, told senators it's important that Medicare and Medicaid pay at parity, but it can't be only those public insurers.
"The private sector needs to step up as well," Kvedar said. "And it would be very difficult to conduct this care model in a world where we got some payment for some things and didn't get paid for others."
And all health professionals agree that physical offices will still be needed, so there needs to be money to maintain those, too.
BlueCross BlueShield of Tennessee, for one, is committed to keep reimbursing for telehealth indefinitely, even if they will also have to reevaluate the rate of reimbursement. Andrea Willis, the insurer's vice president, told Senators patients have been extremely satisfied with the service and it makes fiscal sense.
"We're going to gain efficiencies, we're going to keep people out of the ER that don't need to be there, and we think people are going to get care that they may have forgone, so down the line, we do think that it will save money," Willis said.
But even beyond insurance reimbursement and government regulations, there are still hurdles for telehealth. Broadband access remains a roadblock for many – especially in rural counties across the Mountain West where the service is most needed.
This story was produced by the Mountain West News Bureau, a collaboration between Wyoming Public Media, Boise State Public Radio in Idaho, KUNR in Nevada, the O'Connor Center for the Rocky Mountain West in Montana, KUNC in Colorado, KUNM in New Mexico, with support from affiliate stations across the region. Funding for the Mountain West News Bureau is provided in part by the Corporation for Public Broadcasting.