In a year with few victories to celebrate, advocates for expanded health care in Massachusetts are pointing to at least one win: More access to remote health care, or "telehealth."
Since early in the pandemic, health insurers have been required to cover telehealth visits as they would in-person care under emergency orders from Gov. Charlie Baker. On Wednesday, Massachusetts lawmakers passed a health care bill that makes that change permanent.
The new legislation will now go to Gov. Charlie Baker's desk to be signed. It will require equity in coverage and reimbursement for all clinically appropriate telehealth visits for behavioral health, including addiction and mental health care. It would also require similar equity for primary care and care for chronic conditions for the next two years.
The move represents an acknowledgement that telehealth and remote health services are here to stay.
Telehealth — which includes simply appointments conducted by telephone — has been around for decades. But until this year, it represented a tiny fraction of health care visits nationwide.
The pandemic changed that almost overnight, with telehealth visits shooting from about 1% of all U.S. health visits in January to a peak of nearly 50% this spring, according to the American Telehealth Association, which advocates for expanded use and coverage of telehealth services.
Massachusetts Sen. Cindy Friedman, a sponsor of the new measures, says the natural, if accidental, experiment created by the pandemic has proven the utility of telehealth for certain services, especially behavioral and mental health.
“Behavioral health just alone, no-shows, which used to be over 60%, for a whole host of reasons, all of a sudden that no-show rate (dropped) to something like 5%. Because people all of a sudden had access in a way that they could control," the Middlesex Democrat said.
Friedman, who was pushing for the changes before the coronavirus pandemic hit, said the need for expanded telehealth is now irrefutable.
“There’s a time and a place," Friedman said. "You can work on something for a very long time and not get traction, and then there’s an outside force that comes long that really crystalizes the need and the urgency of doing something."
“We hit this pandemic, and it was clear where we had gaps in our health care system that we needed to address, immediately and for the long term," she added.
Dr. Lee Schwamm, a physician and vice president for virtual care at Mass General Brigham who has advocated in favor of the legislation, said the measures are about not just patient convenience but also more equitable health care for working families.
“Patients who work lower-wage jobs, who don’t have the flexibility to step away from work for several hours, being able to conduct a 30-minute visit is extraordinarily beneficial for everyone involved,” Schwamm said.“Anything we can do eradicate barriers in accessing needed care means that our patients and our health care system will be safer, healthier and less costly."
While he believes telehealth services will ultimately bring down the costs of delivering health care, Schwamm cautioned that it will take providers some time to adapt.
“We have to recognize that if you add virtual on top of in-person, at the beginning it's an added cost,” he said. “The system only begins to save money when there's a predictable road map, like this bill is going to provide, of several years, and also that you can bring it to scale.”
