By Mitch Mitchell, Group Vice President, Government Solutions, American Well

Today, there are more than 18 million living United States Veterans who bravely served in conflicts ranging from World War II to the Iraq War. Many Veterans have service-connected disabilities, while other conditions like post-traumatic stress disorder (PTSD) and chronic pain are common across all military actions and generations.

Depending on certain factors, Veterans and their families may be eligible for Healthcare coverage through programs such as the VA Civilian Health and Medical Program (CHAMPVA), VA Health Care, and TRICARE. For example, VA Health Care determines medical coverage using a priority system based on factors like service-connected disability, other disability and income level. CHAMPVA—an insurance program for dependents, spouses and surviving spouses of Veterans—eligibility requirements include the Veteran having a service-connected disability (as determined by Veteran Affairs) or the Veteran having died as a result of that service-related disability. TRICARE offers 11 different coverage programs, each with its own eligibility requirements.  For example, TRICARE for Life (TFL) is a program for military members aged 65 or older.

The Medicare Connection

While all these programs have different eligibility requirements, they all can be used in conjunction with Medicare. Many Veterans with Medicare are also eligible for VA Health Care. For those who are covered by both CHAMPVA and Medicare, Medicare is the primary payer of medical bills while CHAMPVA can cover coinsurance amounts and co-payments not covered by Medicare. TRICARE For Life functions as a supplement for those enrolled in Medicare Part A and B, making Medicare the primary insurance.

Because many Veterans are in some way are covered by Medicare, what Medicare does and does not cover is extremely important to the Veteran population. That’s why the policies on telehealth recently finalized by the Centers for Medicare and Medicaid Services (CMS) could change the way we care for our Veterans.

Key Changes

These CMS policies extend telehealth coverage for Medicare members through the creation of a new service called the “brief virtual check-in,” as well as eliminate geographic restrictions for opioid addiction treatment, telestroke, and dialysis monthly check-ins. CMS also created additional CPT codes for remote patient monitoring and provider-to-provider consults. Additionally, beginning in 2020, Medicare Advantage plans can offer telehealth services as a basic benefit for members.

These changes in reimbursement policy are opening new doors for telehealth among the older Veteran population. And with nearly 25% of U.S. Veterans living in rural areas, this will better allow Healthcare organizations to deliver needed care to those with limited access to medical specialists. To put it into perspective, here are few examples of how CMS’ recent policy changes will positively impact Veterans covered by Medicare:

Hypertension: According to the Blue Cross Blue Shield Health Index, hypertension is the top health condition impacting Americans today. While hypertension affects all age groups, it is most common among older populations. In the United States, 76% of those between the ages of 65 and 74 and 82% of those over 75 years old have hypertension. Veterans—especially those who have seen multiple tours or combat—are especially susceptible to hypertension due to certain aspects of their career, from being in high-stress situations to being exposed to certain chemicals such as Agent Orange. Hypertension is a major cause of morbidity and mortality and can often lead to serious complications such as congestive heart failure, stroke, heart attack, or kidney disease. Thanks to CMS’ recent policy changes, telehealth can now be used to help monitor and care for patients with hypertension. Patients who present in the emergency department or doctor’s office with hypertension can then be monitored at home and have virtual check ins using a combination of remote patient monitoring and telehealth.

End-Stage Renal Disease: The prevalence of chronic kidney disease in the veteran population is estimated to be 34% higher than in the civilian population. If one’s kidneys become severely damaged, that person will need to be treated for end-stage renal disease (ESRD), often undergoing three to five hours of dialysis treatment three or more times a week. ESRD is also often accompanied by other chronic conditions that need to be treated or maintained. As part of CMS’ new telehealth reimbursement policy, geographic restrictions have been lifted for virtual dialysis patients’ follow-up appointments. Now ESRD patients can receive care in the home, changing the way Healthcare organizations approach dialysis care. For example, Intermountain Healthcare recently announced a new Kidney Care Center that will provide at-home dialysis visits through telehealth to treat ESRD patients virtually. The health system believes incorporating virtual care into an ESRD patient’s care plan will decrease costs, help avoid unnecessary ED utilization and improve the patient experience.

Stroke: Veterans Affairs estimates that 15,000 Veterans are hospitalized each year for a stroke. CMS’ new policies eliminate the geographic restrictions for telestroke, meaning patients who are suffering from a stroke in remote areas now have more immediate access to care. Because stroke treatment time has a profound impact on patient outcomes, this is incredibly important for Veterans in rural areas. University of Alabama at Birmingham (UAB) Medicine, an academic health center located in Alabama, recently partnered with rural hospitals across the state to better care for critical stroke patients. Through this telestroke program, UAB Medicine has achieved a time-to-evaluation of six minutes for rural stroke patients, which means they are getting critical, life-saving care sooner.

Mental Health: While not included in CMS’ recent policy update, a bill has been introduced in Congress that would eliminate the rural and site restrictions for telemental health care in the home.  Mental health is an ongoing issue for many Veterans who suffer from everything from PTSD and traumatic brain injuries to depression and substance use disorders. There are many barriers to mental Healthcare for Veterans, including access, long wait times, provider shortages and stigma. Telehealth can help address these barriers while also providing high quality care to Veterans when and where they need it.

Thanks to CMS’ new reimbursement policies for Medicare members, Healthcare organizations across the country are building telehealth programs to better care for the vulnerable population. Veterans will undoubtably benefit from these changes. The hope is that as CMS continues to loosen restrictions on telehealth reimbursement, they keep the Veteran population—and their health conditions—in mind.

About W.B. “Mitch” Mitchell

W.B. “Mitch” Mitchell is Group Vice President, Government Solutions with American Well. Mitch is a senior strategy and management professional with over 25 years passionately building businesses in Healthcare and Information Technology. He combines expertise in Military and Veteran’s Health, Federal Health Programs, Patient Engagement and Clinical eHealth Strategy Development. Before joining American Well, Mitch led Government Solutions for Ciox Health and for 15 years prior, he led teams across McKesson/RelayHealth and Change Healthcare, supporting complex commercial and Federal Health IT, Health Information Exchange and Patient Engagement programs.



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