Digital health coverage 'not yet fully realized' across commercial payers: AMA study

There's a lack of commercial coverage for digital healthcare services compared to publicly-funded health plans, which is limiting access to care for more than half of the U.S. population, according to new research published by the AMA on Sept. 19.

The research summarizes coverage policies for 16 commercial payers for 21 unique digital medicine services. The 21 services fall into four categories: remote physiologic monitoring, remote therapeutic monitoring, electronic consultations and electronic visits.

The payers analyzed include Aetna, BCBS Illinois, Massachusetts, Michigan, North Carolina, Texas, Blue Shield of California, CareFirst BCBS, Cigna, Elevance Health (Anthem), Florida Blue, Highmark, Horizon BCBS New Jersey, Regence, Tufts Health Plan, and UnitedHealth Group.

Six key takeaways:

  1. Medicare and Medicare Advantage plans cover all 21 digital services, but commercial plans do not. Medicaid coverage is also limited but has been expanding.
  2. Most commercial plans cover remote physiologic monitoring and others are considering coverage of remote therapeutic monitoring. Coverage for electronic consults and electronic visits is less common.
  3. Some plans have publicly available clinical coverage policies for digital medicine services, but many don't or it's hard to find. 
  4. There is no specific timeline for reviewing and making coverage decisions about the digital medicine services for payers, creating uncertainty around digital health programs.
  5. Commercial payers say a limited number of healthcare professionals use digital medicine, but they are interested in more information.
  6. Commercial payers have partnered with external technology companies to provide direct access to digital services, but these partnerships are often disconnected from patients and their physician.

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