How Halting Telehealth Waivers May Impact Cost, Deferral in Care

As some private health insurance companies move to end waivers of cost sharing for virtual care due to the coronavirus disease 2019 (COVID-19) pandemic, there will be several aspects to monitor for employers, particularly its impact on accessibility and potential deferral of health care services, said Ben Isgur, MPA, Health Research Institute leader at PwC.

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The American Journal of Managed Care^® (AJMC^®):  Hello, I'm Matthew Gavidia. Today on the MJH Life Sciences’ Medical World News, The American Journal of Managed Care® is pleased to welcome Ben Isgur, Health Research Institute Leader at PricewaterhouseCoopers, or PwC.

Great to have you back, Ben, can you just introduce yourself and tell us a little bit about your work?

Isgur: Sure, well, thanks for having me back! I'm Ben Isgur, I lead PwC’s Health Research Institute, and we're the think tank within PwC that covers health industry trends, and that includes what's happening for pharma and life sciences companies, providers, and payers. It runs across the gamut of technology changes, policy and regulatory changes, and business model changes. So, that's our job to cover those and to see what's coming next.

AJMC®: As a response to the pandemic, virtual care has expanded exponentially aided by health insurance companies who began to waive telehealth copays for non–COVID-related issues. Fast forward to where we are now, virtual care is still crucial amid surges in COVID-19 cases but some private health insurance companies have moved to stop waiving telehealth. Can you explain why some private health insurers are choosing to end these waivers, particularly now?

Isgur: First of all, I think you made a great point at the beginning just to set it up, which is we have seen a large explosion in the use of telehealth because of the pandemic. In fact, at the height of the Spring portion of the pandemic, our own studies showed that more than 16 million Americans had a virtual visit for the very first time, and that included people all across the spectrum in terms of their insurance status. So, from the uninsured, to Medicaid and Medicare, to those with employer-sponsored plans.

The question is, why was there so much use during the pandemic? Well, the main reason was because that was the way to get a health visit at that time. And so, the government and many payers decided to act and to reduce cost sharing—in some cases, there was no cost sharing at all, for a telehealth visit. Now we're seeing that change, and what I could say is, if you look at the history of most benefit plans, the way they are set up, typically, there is going to be some cost sharing in some way. Either people have a deductible, or they have copays or coinsurance, or maybe a combination of all 3—modern day health plans, almost all of them have cost sharing.

What cost sharing does, kind of the purpose of it is it manages utilization. So, the idea being that when something is free, that there is sometimes someone could consider that there might be overuse. So, you almost induce demand, because there's no cost sharing at the point of care. So, as we've moved kind of farther into this virtual health world and the pandemic going on, there are some payers that are putting cost sharing back, and really, what that leads us to is the fact that we might have lower utilization of virtual health over the next few months as a result.

AJMC®: How can this decision to end telehealth waivers impact overall health care costs for patients and employers? And do you foresee increased deferral in health care due to this?

Isgur: Well, I think your last point, Matt, is kind of the big question, and that is deferral of care. Anytime a barrier is put up, and a barrier can be cost sharing, a barrier could be access, and you have less care, we have to really try to understand, was that care that was actually needed? And it was going to prevent something that can be much more costly down the line, like an emergency room visit or hospitalization, or was it care that really wasn't needed?

By the way, these are questions that the health system has dealt with even prior to the pandemic. I mean, many employer-based health plans and health plans that are offered in the health insurance exchanges have a lot of cost sharing, and that cost sharing has gone up over time. Our own studies have shown that as that cost sharing goes up, utilization goes down, and people are foregoing care. Consumer surveys that we have run even prior to the pandemic showed that people were forgoing primary care visits, getting prescriptions filled, sometimes even referrals to see specialists, delaying surgeries and procedures.

So, it can be very concerning when you're managing the health of an employee population or a community when you're starting to see that people are no longer having some of that same access. I think the question is going to be going forward, as telehealth and virtual health visits go back to having some cost sharing, like they did prior to the pandemic, it'll be really important to kind of watch what happens to people's health, because some consumers aren't really yet ready to go back to a lot of in-person visits. And so the virtual health option is the way that they're seeking health care. It's the way they're getting access, and that's important, especially for people who have chronic conditions, that we're managing those chronic conditions.

Our research shows that about 11% of the US population, actually are living with unmanaged chronic conditions. So, if they don't get that regular input and help from the health community and health providers, that could very well result in something much worse farther down the line.