The American Medical Association (AMA) has released new research examining the state of digital health advancement in the commercial health insurance industry. The research compares current coverage across private health insurers and explores how coverage decisions are made for digitally enabled care services.
The study found that while the United States has entered an era of integrating digitally enabled care with in-person care, the full potential of this hybridized care model has not yet been realized. The lack of commercial coverage for digital medicine services poses a roadblock to affordable access for over half of the U.S. population who rely on private health insurance.
The research focused on 21 unique digital medicine services, categorized into remote physiologic monitoring, remote therapeutic monitoring, electronic consultations, and electronic visits. It analyzed the coverage policies of 16 commercial health insurers, including Aetna, Blue Cross Blue Shield, Cigna, and UnitedHealth Group.
Key themes emerged from the research regarding commercial payer coverage of digital medicine. One notable finding was the lack of coverage alignment across commercial payers, Medicare, and Medicaid. While Medicare and Medicare Advantage plans cover all 21 digital medicine services, private health plans in the commercial market do not offer the same coverage. Medicaid coverage is more limited but has been expanding over time.
The research also highlighted inconsistent coverage policies within the commercial market. While most commercial payers cover remote physiologic monitoring, coverage for newer remote therapeutic monitoring services is still being considered. Coverage of electronic consults and electronic visits also varies.
Transparency of coverage policies for digital medicine services is highly variable across commercial payers. Some plans have publicly available clinical coverage policies, while others have no publicly available information or difficult-to-access information. This lack of transparency hinders informed decision-making for patients and physicians.
Commercial payers contend that coverage decisions about digital medicine services have no specific timeline, resulting in a time lag before services are covered. This uncertainty complicates planning and investment in digital health programs.
Furthermore, the utilization of new digital medicine services healthcare professionals is limited. Commercial payers are eager for more information on the impact and quality of these services to inform coverage decisions.
Although some commercial payers have partnered with health tech companies to provide access to digital services, these programs are often disconnected from a patient’s medical home or primary care physician, further fragmenting care.
The AMA is working towards harnessing the full potential of digitally enabled care to improve access, quality, outcomes, affordability, and health equity. They aim to involve physicians in the design, implementation, and evaluation of innovative technology and ensure that digital tools integrate seamlessly with medical practices.
The American Medical Association (AMA) is the leading medical association representing physicians with a unified voice to all key players in healthcare. It works to remove obstacles interfering with patient care, prevent chronic disease, and address public health crises.
Source: American Medical Association (AMA)