What Cowboy Hats and Cost Commissions Have in Common

So what DO cowboy hats and Colorado’s Commission on Affordable Health Care have in common?

You’ll never guess, so I’ll tell you: they’re both interested in telehealth.

Earlier this month, Governor Hickenlooper signed House Bill 1094, titled “Telehealth Coverage Under Health Benefit Plans.” The cowboy hats were clearly a trend.

The law makes some tweaks to the way Colorado governs the use of telehealth.

It modifies the current requirements for health benefit plans to cover services delivered via telehealth. For example, insurance plans can’t restrict reimbursement based on the type of technology or application used to deliver telehealth. The concern is that insurers might otherwise only reimburse for telehealth delivered via their own app and no one else’s. This law prevents that scenario.

But the service must include an audio-visual component. So care delivered via text, for instance, won’t be covered.

The bill was sponsored by Rep. Perry Buck (R), Rep. Donald Valdez (D), Sen. Kerry Donovan (D) and Sen. Larry Crowder (R).

Colorado’s state legislature isn’t alone in its interest in telehealth.

Colorado’s cost commission is also bringing attention to telehealth. The commission is tasked with findings ways to make health care more affordable and cost effective. It’s looking at telehealth as a potential solution.

The commissioners are especially interested in how expanding telehealth could impact rural areas, both in terms of cost of care and access. CHI is providing research support on the project.

We’re finding that Colorado is already far down the road of expanding telehealth.

So what IS telehealth anyway?

It’s a good question. Across 50 states there are 50 definitions. The general consensus is that telehealth is the use of technology to facilitate the delivery of health care, often to distant locations. It’s an umbrella term that includes things like e-consults and patients monitoring their health at home with remote devices like blood pressure monitors. But it also includes patient-provider interactions like live psychotherapy counseling sessions conducted via video.

Colorado legislators are not new to telehealth. The state has passed several laws over recent years to expand the practice.

In 2015, Colorado adopted its landmark telehealth legislation, House Bill 15-1029. The law expanded coverage for telehealth by requiring health insurers to reimburse for telehealth services at the same level as in-person services, in urban as well as rural areas. Previously, Colorado law only required reimbursement for telehealth services provided to patients in rural areas.

In 2016, Colorado passed House Bill 16-1047 and joined the ranks of states participating in interstate medical licensure compacts to increase the use of telehealth across state lines.

And telehealth programs in Colorado have been growing ever since. There are many examples of robust telehealth programs right here in the state — from HealthONE’s telestroke program to Banner Health’s tele-ICU program.

But a key question is whether telehealth “works.” Does it work to improve health and health care? What does it do for costs and utilization?

There’s the rub. Not all telehealth is created equal in terms of costs and benefits.

Telehealth’s impact on health care quality and cost depends on several factors. It depends on which telehealth service we’re considering — for example, live video or remote monitoring. It depends on which patient population or clinical indication it’s being used for — whether we’re talking about patients with chronic disease or acutely ill patients in the ICU. And finally, it depends on how it’s reimbursed. Are we in a fee-for-service world or a value-based care world?

And a number of concerns about using telehealth still exist. Usually these are related to protecting patients or providers, like ensuring HIPAA compliance and avoiding potential malpractice. But there’s also the question of broadband access, and how to maintain strong and trusting patient-provider relationships over the internet. 

Meantime, telehealth carries on. We expect to see additional policies that help clarify the regulations and billing rules around telehealth in Colorado. In this case, the more information the better. Same goes for the cowboy hats.