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Issue Brief Urges States to Be Careful in Regulating Home Telehealth

Published Friday, September 6, 2019

Healthcare providers are launching home-based telehealth programs faster than states or the federal government can draft guidelines for them. This could hinder efforts to define their value and boost sustainability and scalability.

That’s the opinion put forth by the Milbank Memorial Fund in a new issue brief. It notes that telehealth programs providing care in the home and other non-clinical settings are evolving faster than the evidence supporting them, giving policymakers little support as they rush to draft legislation.

Developed from research into state Medicaid, Medicare and private payer policies, the issue brief describes a scramble to move care out of the hospital and closer to the patient. Hundreds of bills are being or have been introduced at the state and federal levels to define and regulate telehealth and mHealth. Providers, meanwhile, are developing platforms to monitor complex patients at home and direct-to-consumer services to keep the minor, quick-fix cases out of the office or ER. And payers, mindful of consumer demand, are looking to support those new avenues of care.

“If directed and utilized appropriately, telehealth in the home provides a potential opportunity to make health care more efficient,” the brief, written by Brittany Lazur, MPH, Andrea Bennett, PHD, and Valerie King, MD, MPH, concludes. “However, because the rate of telehealth adoption has historically outpaced the evidence supporting its use, policymakers will continue to develop telehealth services with little guidance from research.”

If policymakers – particularly at the state level – don’t realize the limitations of the data they have at their disposal, they could draft guidelines that are ineffective or detrimental to the growth of connected care, hindering efforts to build an evidence base and support their growth.

Noting that most research into home-based telehealth is “generally old (published more than 10 years ago), of poor-methodological-quality and lacking generalizability to diverse patient populations,” the researchers suggest drafting regulations that look forward rather than back, and meet the needs of advocacy groups, payers and the government.

The brief urges state policymakers to develop guidelines consistent with their goals for connected health, and which can be integrated into care delivery and payment models. To that end, the brief offers five lessons:

  1. “Patients and clinicians are generally responsible for obtaining telehealth equipment and technology, as well as for ensuring visit privacy and confidentiality. Program administrators need to determine the level of detail to include in written policy to help curtail potential issues related to patient safety, privacy and access to telehealth services, especially as telehealth continues to evolve.”
  2. “Policymakers need to consider how telehealth in the home works as a model for health care delivery for low-income and vulnerable populations, who may not have sufficient connectivity in rural or underserved areas. Patients in these areas may face more challenges to obtaining hardware, ensuring privacy, and acquiring technology literacy, which could create greater barriers to appropriate telehealth use than other populations.”
  3. “Medicaid programs do not currently have methods to track and monitor the use of telehealth in the home. State officials may want to ensure their telehealth policies capture more information, such as patients’ home address, in order to track and monitor use and facilitate quality control and data analysis.”
  4. “While telehealth in the home has the potential to make health care more efficient, it also has the potential to increase fragmentation and impede coordination of care. To reduce the potential for care fragmentation, telehealth services should be coordinated with other health services. To this end, telehealth policies could require that information is shared with the patient’s care team.”
  5. “Rigorous program evaluations are needed to measure the success, feasibility, and sustainability of telehealth in the home and other nonclinical settings. Future research is also needed to determine the clinical conditions and types of patients that can be well served by telehealth in these settings.”

The issue brief was based on a report prepared for the Medicaid Evidence-based Decisions Project (MED), a research collaboration of 21 state Medicaid programs based at the Center for Evidence-based Policy at Oregon Health and Science University.