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The Centers for Medicare & Medicaid Services have recognized two Pennsylvania insurers for excellence in service.

UPMC Health Plan’s UPMC for Life and Independence Blue Cross’ (Independence) Keystone 65 HMO Medicare Advantage plans both received five-star ratings from CMS.

UPMC also earned accreditation from the National Committee for Quality Assurance (NCQA) for both its HMO and PPO plans.

CMS also recognized Independence’s Personal Choice 65 PPO plans and UPMC for Life‘s Special Needs Plan (SNP) in Western and Central Pennsylvania with four-and-a-half star ratings.

“We are proud to have earned another five-star recognition from CMS, and believe it reflects our commitment to providing our members outstanding service, support, and access to high-quality health care,” said Independence Blue Cross President and CEO Gregory E. Deavens. “This accomplishment validates the advantage of our team’s collaborative approach to engaging members and delivering valuable and reliable benefits.”

When a plan earns five stars it receives more funding to enhance member benefits and can be sold all year, not just during open enrollment, Independence Blue Cross said.

Diane Holder, president, and CEO, UPMC Health Plan, said, “By recognizing our Medicare plans, CMS confirms what our members already know: UPMC Health Plan is committed to providing access to the best care, the best coverage, and the best customer service each and every time.”

The Star Ratings were created by CMS to help individuals and caregivers compare the performance and quality of Medicare Advantage plans and Part D prescription drug plans, CMS said.

They are published annually and provide a scorecard on each plan’s quality and performance measures (e.g., member compliance with preventive care and screening recommendations, chronic condition management, customer service, access to care, and more).

NCQA’s Health Equity Accreditation evaluates how well an organization has established a standardized framework for turning health equity into a culture of continuous improvement.

UPMC said the organization builds an internal culture that supports diversity, equity, and inclusion; collects data to understand population demographics; offers language services and provider networks that consider individuals’ cultural and linguistic needs; and identifies opportunities to reduce health inequities and improve care.

“These accomplishments reflect our commitment to continuous improvement, mitigating disparities in health care, and providing our vulnerable members and patients the very best in clinical care and service,” said Carrie Whitcher, chief quality officer and vice president of quality performance, UPMC Insurance Services. “Our network of high-quality physicians and dedicated employees maintain an unwavering promise to keep people healthy.”

Health care providers supercharged their telemedicine offerings as a result of the pandemic—however, how those providers will be reimbursed for virtual care moving forward is in question.

Prior to the pandemic, most providers did not receive enough reimbursements from insurance companies to justify expanding their telehealth coverage.

That changed when the Centers for Medicare & Medical Services, a federal agency that oversees Medicare and Medicaid programs across the country, introduced leniencies on HIPPA requirements on video software and broadened access to Medicare telehealth services.

Third party payers followed suit by expanding their telehealth service coverage, offering advanced payments to independent health care providers and waiving fees for members using virtual care.

Coverage that was previously based on the discretion of insurance companies, has become common across insurers, said Andy Carter, president and CEO of the Hospital Association of Pennsylvania (HAP).

“The number one impediment to telehealth expansion was that there was no payment model that you could get return on your investment because a lot of insurers wouldn’t pay for telehealth consults or appointments,” said Carter. “COVID changed that dramatically, where immediately public payers and private payers were paying for it across the board.”

In a 2022 report on national survey trends in telehealth use, researchers with the US Office of Health Policy noted that from March to April 2020, telehealth use skyrocketed across the country from 1% to 80% in “places where the pandemic prevalence was high.”

Today, patient usage of telehealth is significantly down from the days of quarantine, with the report finding that percentage had dropped to around 20% among adult respondents to a survey given between Sept. 29 and Oct. 11, 2021.

Providers see telehealth usage remaining much higher than pre-pandemic levels with the focus now turning to how providers and insurers can work together to standardize telehealth.

Standardizing telehealth

HAP has spent years trying to standardize telehealth protocols and practices, particularly when it comes to reimbursing providers for telehealth services.

Their most recent effort on that front has been backing Senate Bill 705, legislation that would require insurers to pay providers no matter if that provider is in that insurers’ network.

Carter said that in the past, the association supported bills that would provide parity between in-person and virtual care, meaning that payers would need to reimburse providers equally for either service, but the association has now agreed to leave pricing to individual payers and providers.

“We argue that standardization is hugely important,” said Carter. “Insurance is already complicated enough and a patient’s access to care through telehealth should not be a lottery. Parity was a nonstarter for our friends in the insurance community. We agreed to new language as an alternative.”

HAP is also currently in support of House Bill 2419, which would allow for more flexibility for the state to allow providers to offer mental health services through telehealth permanently.

House Bill 2419 has been passed in the House and is currently awaiting consideration in the Senate.

Pennsylvania’s COVID-era waivers that explicitly authorized telehealth services to expand during the pandemic will expire this October.

The waivers were set to expire at the End of June and were extended by the General Assembly on June 30.

The waivers expand access to telehealth services, increase vaccine access, allow hospitals to quickly adapt to emergencies by altering space as needed for influxes of patients, and ease regulatory barriers to clinician licensing.

Pennsylvania does not have any statutes that will prohibit the practice of telemedicine after the waivers expire but payers will be able to stop reimbursing for telehealth.

“Absent the current COVID driven waivers and flexibilities, we won’t sustain telehealth the way we did before COVID,” said Carter. “It’s not supposed to go away. People got used to it.”

Providing care in the virtual space

In the two years since providers have embraced telehealth, virtual care has had a massive impact on how the industry cares for patients.

Providers are now looking at how things like wearable technology and remote patient monitoring can keep tabs on patient health between visits, said Christopher LaCoe, vice president of virtual health at Penn State Health.

“We’ve moved to the point where we have all these opportunities to do checkups for diabetes. We might be able to do that stuff here and then send (the diabetic patient) to the eye doctor and not make them drive to our office,” said LaCoe, adding that educators are now taking telehealth services into consideration when they teach incoming providers. “Medical schools are putting this in their curriculum. They used to say you need to see diabetic (patients) every three months and now they say once a year.”

LaCoe, credited the waivers, calling the changes that happened to telehealth the pandemic’s “silver lining.”

Pittsburgh-based Highmark Health was early to the market on allowing telehealth for its providers, but prior to the pandemic, providers had little guidance on what that should look like, said Dr. Tim Law, vice president and executive medical director at Highmark.

“Highmark said you can do telehealth, but we won’t tell you how to do it—it wasn’t front and center,” said Law, noting that changed quickly during the pandemic. “We put together a virtual care playbook. Five years ago, I don’t think anyone would have thought of doing this. It includes where to find supplies, how to access Bluetooth technology so you can do remote patient monitoring and we show them what states allow providers to work across state borders.”

Highmark provides parity for its covered providers using telehealth with some of the states the payer operates in mandating it.

However, even though some insurers are ahead of the curve with how they support and pay for telehealth with their covered providers, providers outside of a network may find themselves without telehealth reimbursements, said Carter.

“Some insurers will say we provide telehealth to our covered lives. It’s only to the telehealth providers they’ve enrolled in their network,” said Carter. “That’s a model that leaves a lot of people without access to their preferred provider. Someone they know and trust.”

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COVID-era waivers expanding telehealth reimbursements set to end this year

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