Can Telemedicine Help Address Concerns with Network Adequacy?

Opportunities and Challenges in Six States

Insurers could meet state provider network requirements by covering more telemedicine, making it easier to get access to health care—especially for those living in rural or underserved urban areas.

The Issue
Through interviews with researchers in six states—Arkansas, Colorado, Illinois, Maine, Texas and Washington—the study finds that insurers generally have not incorporated telemedicine providers into their networks, despite widespread physician shortages in some areas.

Key Findings

  • The interviewees said that telemedicine could expand access to primary care, as well as specialists including psychiatrists, cardiologists and endocrinologists, but that insurers are more likely to use it as a supplement to, not a replacement for, in-person services.

  • Insurers are reluctant to use telemedicine to meet state network requirements in part because they do not know how it will be viewed by state regulators.

Conclusion
The authors say that insurers also often face opposition from local clinicians who think telemedicine could replace them, or be used as leverage against them in negotiations over fees.

About Georgetown University’s Health Policy Institute—Center on Health Insurance Reforms
The Center on Health Insurance Reforms at Georgetown University’s Health Policy Institute is a nonpartisan, expert team of faculty and staff dedicated to conducting research on the complex and developing relationship between state and federal oversight of the health insurance marketplace.

About the Urban Institute
The nonprofit Urban Institute is dedicated to elevating the debate on social and economic policy. For nearly five decades, Urban scholars have conducted research and offered evidence-based solutions that improve lives and strengthen communities across a rapidly urbanizing world. Their objective research helps expand opportunities for all, reduce hardship among the most vulnerable, and strengthen the effectiveness of the public sector. Visit the Urban Institute’s Health Policy Center for more information specific to its staff and its recent research.