With the Omicron variant causing a spike in COVID-19 cases across the country, access to telehealth visits is likely a benefit that many plan members are continuing to value and use. Nearly two years into a sort of forced experiment with telehealth, what should employee benefit plans keep in mind as they promote the use of virtual health care visits to their plan members? In a recent Benefits Magazine article, “Telehealth Truths Revealed: What the Pandemic Taught Our Fund” Lisa Kaiser, CEBS, ISCEBS-Fellow, offers some thoughts on her fund’s experience since the pandemic began. Kaiser is administrator of the Plumbers and Pipefitters Local 189 health and welfare fund in Columbus, Ohio.

Among the lessons learned by the fund during the first year of the pandemic:

  • Members prefer virtual visits with their own doctors rather than seeing random, unknown doctors (who might be in a different geographic areas) through an add-on telehealth benefit.
  • Members have embraced using telehealth for mental health care.
  • Opinions vary. Many members like the convenience and will continue to use telehealth. Others were willing to try it temporarily but would prefer returning to the previous model of care once the pandemic subsides. Still others are suspicious and worry about factors such as privacy and whether they will be able to access in-person visits at the same price.

Members have begun using telehealth for nonprimary or nonurgent care and are seeing specialists, for example physical therapists, online. Because most members prefer seeing their regular doctors who charge the same rates as for in-person visits, the fund has not realized savings from the shift to virtual care. Kaiser also offered some considerations for plan administrators and trustees to keep in mind when promoting and administering their health plans, including whether members have equal access to virtual care.

“As great as technology (when it works) can be, there are important communities within your membership or employees who may get left behind and are not able to easily access their physician of choice through a televisit,” Kaiser writes, identifying the following challenges:

  • Low tech. Members may have an outdated system or browser or, just as likely, they do not fully feel comfortable with using the browser or accessing the portal without assistance.
  • Low connectivity. This is a big issue in rural areas, or service may be spotty at place of employment or residence. A steady phone signal or broadband connection are necessary to have a seamless interaction.
  • Language barriers. Navigating the health care system in your second language can be a challenge, and it can be more daunting when there is another layer of complexity added to it.
  • Aging (but not all).  No demographic is a monolith and, many, many seniors are comfortable with smartphones or web browsing, but there remains a hesitancy among the more aged seniors. If you have a retiree health plan, this is an area where you might be able to provide support.

Funds may need to consider additional education or creative solutions to help members who are affected by these challenges get connected.

Use of telehealth is expected to continue, so Kaiser points out that plans need to focus on compliance while maintaining a focus on plan goals.

She offers the following to-do list:

  • Keep plan documentation current: Summaries of material modification (SMMs) should be issued for each series of plan changes, including extensions of waived or reduced copays for televisits.
  • Confirm mental health parity compliance: Check with your advisors, including your attorney. If you can provide a specialist visit through a portal, is there parity with how you’re treating mental health providers who can also deliver televisits? Check (and then include that in your documentation too). This is especially important as you analyze and document your compliance with the Mental Health Parity and Addiction Equity Act (MHPAEA) through the nonquantitative treatment limit (NQTL) assessment.
  • For plans with on-site or near-site clinics: See if you can get data regarding a breakdown of phone vs. video visits. Communicate with the staff to determine what the trends are in televisits for your population and how this may affect clinic staffing levels or hours in the future.

“Having the ability to access care—both physical and behavioral—through telehealth services was vital to helping plan members maintain good health during the pandemic,” Kaiser concludes. “This capability may continue to hold value for certain segments of plan populations, depending on where they live and the type of care they seek.”

However, she adds, “At the risk of sounding like an article on investments, ‘past results do not indicate future performance— actual results may vary.’ Health and welfare funds would be wise to monitor trends among health care providers and plan members.”

Kathy Bergstrom, CEBS
Senior Editor, Publications at the International Foundation of Employee Benefit Plans

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Kathy Bergstrom, CEBS

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