Podcast: Brian Powers on How Humana Understands Social Needs
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Tuesday, May 3, 2022 | The Latest Research, Commentary, And News From
Health Affairs

Dear John,

Today's newsletter comes from the desks of Sanuja Bose, a master of
public health student at Johns Hopkins Bloomberg School of Public
Health, and Caitlin Hicks, an associate professor of surgery at Johns
Hopkins University School of Medicine.

From Sanuja Bose And Caitlin Hicks

For an article in the most recent issue of Health Affairs
,
our team explored changes in telemedicine use during the COVID-19
pandemic.

We analyzed nearly 30 million Medicare fee-for-service claims from
January 2019 to March 2021, which revealed a sharp increase in
telemedicine use

starting in March 2020.

Read The Study

This may not sound surprising, but our most meaningful finding was not
in the overall numbers, but the characteristics of the populations
assessed.

We found telemedicine reached patients in even the most disadvantaged
neighborhoods in the country. We hope this comes as a relief to readers.

In March 2020, Congress waived barriers

to expand the scope of telemedicine coverage in response to the COVID-19
pandemic. The intention of the waiver was to improve access to the
health care system for all Medicare beneficiaries when in-person visits
were being limited.

There were concerns about this expansion amid national discussions that
the pandemic was exacerbating preexisting health disparities.

With morbidity and mortality in marginalized populations being reported
in disproportionate numbers, this fueled a fear that increasing
telemedicine coverage would further worsen these disparities.

Critics of the waiver suggested that expanding the scope of telemedicine
would only improve health care access for the most fortunate-those
with the best Internet and up-to-date smart phones-while others were
left behind.

With our unique access to 100 percent of Medicare fee-for-service
claims, we had the opportunity to investigate this fear on a national
scale.

We were relieved to find that the rapid increase in telemedicine use
after the wavier was not associated with worsening disparities.

In fact, patients living in the most disadvantaged neighborhoods
experienced the greatest net increase in telemedicine use relative to
their counterparts living in the least disadvantaged neighborhoods.

The only population that did not experience a dramatic increase in
telemedicine use were elderly patients-revealing a population that
could benefit from targeted interventions to improve their access.

On a more personal scale, we work predominantly with patients with
vascular disease, the majority of whom are covered by Medicare.

Many of our patients live in deprived neighborhoods in inner city
Baltimore. When the telemedicine waiver first took effect, our anecdotal
impression was that telemedicine was not a helpful resource for our
patients.

Time, experience, and the results of this investigation proved us wrong.

Our findings give us incentive to strengthen this resource in vascular
surgery clinics. Telemedicine gives us the means to review imaging or
test results, check in on patients, and provide an overview of upcoming
surgeries without interrupting the day-to-day lives of our patients.

This is not to say that we prefer seeing our patients virtually, or that
this is equivalent to personally conducting wound checks, dressing
changes, and in-person physical exams, but there are barriers to care
that predated the pandemic that will continue to exist long after, and
telemedicine may help to bridge this gap.

Now, more than two years after the start of the pandemic and the initial
surge in telemedicine use, how much does this continue to matter?

The declaration of the nationwide public health emergency

was last renewed on April 12, 2022, continuing the waiver that allows
telemedicine coverage to persist at least through July 15, 2022.

However, when this declaration officially ends in the future, broad
telemedicine coverage will be lost unless regulations permanently
change.

While we miss the normalcy of regular in-person health care visits, our
analysis revealed the potential telemedicine has to reach different
populations, supporting it becoming part of our new normal.

Even when in-person appointments are considered safe, safe does not
necessarily mean accessible.

In an ideal world, there would be no barriers to health care access for
anyone, but reality is far less than ideal.

By reducing fears that the waiver has worsened disparities in health
care access, we hope our study provides motivation to advocate for
continued telemedicine coverage beyond the nationwide public health
emergency.

As long as the Centers for Medicare and Medicaid Services cover
telemedicine for all its patients, we have the opportunity to strengthen
the health care system to make it as accessible as possible for patients
of all backgrounds.

Order The Issue

Last week, we announced that Shekinah A. Fashaw-Walters, an author in
the February issue of Health Affairs, had received the John Heinz
Dissertation Award for her dissertation "Inequities in Home Health
Access, Outcomes, and the Impact of Public Reporting."

We inaccurately stated that the award was from the National Academy of
Science. The award is conferred by the National Academy of Social
Insurance .

Elsewhere At Health Affairs

Blake Shultz and coauthors discuss how millions of Americans carrying
medical debt

are often subjected to a downward financial spiral including lawsuits,
wage garnishment, home liens, and other aggressive debt collection
practices.

In part two of her Forefront series

on the final 2023 Notice of Benefit and Payment Parameters from HHS,
Katie Keith summarizes the changes that are specific to the exchanges.

Robert Field posits that while prospects for a federally run public
option

are slim in a closely divided Congress, they are considerably greater at
the state level.

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Brian Powers On How Humana Understands Medicare Advantage Enrollees'
Social Needs

Listen to Health Affairs Editor-in-Chief Alan Weil interview Humana's
Brian Powers on understanding the unmet social needs of Medicare
Advantage enrollees.

Listen Here

Daily Digest

Medicare Beneficiaries In Disadvantaged Neighborhoods Increased
Telemedicine Use During The COVID-19 Pandemic
Sanuja
Bose et al.

Hospital Debt Collection Practices Require Urgent Reform

Blake N. Shultz et al.

Final 2023 Payment Rule, Part 2: Standard Plans And Other Exchange
Provisions

Katie Keith

The Clearest Road To An ACA Public Option Runs Through The States

Robert I. Field

Podcast: Brian Powers On How Humana Understands Medicare Advantage
Enrollees' Social Needs

Alan Weil and Brian Powers

 

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mailto:[email protected]

About Health Affairs

Health Affairs is the leading peer-reviewed journal
at the intersection of health,
health care, and policy. Published monthly by Project HOPE, the journal
is available in print and online. Late-breaking content is also found
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, and Health Affairs Sunday
Update .  

Project HOPE is a global health and
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health care workers to save lives across the globe. Project HOPE has
published Health Affairs since 1981.

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