Telehealth is a no-brainer for some healthcare disciplines, like talk therapy or infectious disease assessments. Both synchronous and asynchronous technologies have been shown to be effective for increasing access to care for enrollees living in health professionals shortage areas (HPSAs), improving interprofessional care coordination, and triaging visitors to hospital emergency departments.2
In-person visits have fewer limitations for the providers; however, they may also mean the difference between an enrollee getting medical attention or avoiding it due to barriers like time and transportation. And this new technology also has limitations:
- Diagnostic and treatment services that require hands-on treatment by medical and other skilled professionals cannot be completed as easily using telehealth.
- Equipment and bandwidth requirements for high-quality, live video conferencing (i.e., adequate lighting, a high-resolution camera, and a stable high-speed internet connection) can pose difficulties for enrollees and even some providers’ offices.
Consistency is key. In all dental telehealth interactions, quality of care must be equal for telehealth and in-person, with the same materials available. The American Dental Association (ADA) has even updated Patients’ Rights to reflect the use of teledentistry, given its proliferation.3 Quality of both care and technology will play an important role in the future of teledentistry specifically and telemedicine generally.
As a general rule, if the problem is happening in front of the eye—that is, if it can be seen in the mirror—a telehealth visit may suffice. Styes, corneal abrasions, conjunctivitis, and some routine follow-up visits can be handled remotely.5 Add the flexibility of after-hours availability for physicians on call, and this is especially helpful for keeping enrollees out of the emergency department.
Here’s where telemedicine can help members or healthcare providers with vision:
Of course, any condition that threatens vision should be taken to the ER.
The American Dental Association (ADA) confirms that face-to-face visits have been the best way to deliver dental care. However, “examinations performed using teledentistry can be an effective way to extend the reach of dental professional.”5
Here’s where telehealth can help specifically in dental care, until the enrollee can make an in-person visit:
Telehealth is an essential component in our Urgent Dental Services program. This program helps to direct enrollees—through, among other methods, telehealth triage—to an appropriate setting for treatment.
Dental pain accounts for over two million emergency department (ED) visits a year nationwide, and treatment costs range from about $400 to $1,500.6 And because dentists are typically not among the staff in EDs, this visit can result in palliative treatment that addresses only the symptoms of dental pain. It may also result in an overuse of unnecessary opioid painkillers.
On the other hand, the cost of a visit to the dentist that begins with a telehealth triage call averages below $2006 and gets to the root of the dental problem.
There are many ways your third-party ancillary benefits managers can help you, your enrollees, and their network providers effectively and appropriately leverage these tools to achieve the Quadruple Aim.
At the height of the pandemic, it became clear to many experts that broadband internet access is a super-determinant of health.7 Without reliable internet, individuals may not have access to telehealth, online education, remote work, and even the ability to safely shop for healthy food and personal hygiene supplies needed to maintain at-home preventive care routines. In some states, we have dedicated care managers to help enrollees find connectivity resources. In others, we work with groups like California’s Aunt Bertha to directly link members to community resources. Avēsis also used telehealth during the COVID-19 pandemic to facilitate just under 1,160 educational dental provider visits through a teledentistry visit with our Business Associate, Smile America. Nearly 260 of those enrollees needed urgent dental care, 474 had non-urgent dental issues, and 424 had no evidence of dental issues.8
Another important contributor to SDOH is the use of mobile devices to connect to healthcare. Research shows that more than half of all traffic on the web comes from mobile devices. Enrollees are more likely to rely on responsive websites than they are to use healthcare apps.9
At Avēsis, a Guardian company, we’ve always made it easy for our network doctors to provide healthcare at a distance by continuously monitoring changes in the regulatory environment, ensuring our claims system is updated to adjudicate claims in accordance with the changing regulatory landscape, and keeping our staff and our network providers updated on how telehealth can be used to deliver care.
Avēsis was operationally and clinically ready for telehealth long before the pandemic hit the U.S. In each of our health plans’ states, we had already:
- Prepared the appropriate billable codes for telehealth
- Each state had unique exam services
- Each state had different start dates, modifiers, and place of service codes that had to be implemented and adjudicated by our system
- Educated our Provider Relations staff to let the networks in each state know that telehealth is available
- Informed our state advisory boards about our telehealth capabilities
- Run monthly reports to monitor the appropriate use and adjudication of telehealth claims
As an ancillary benefits manager operating in Medicaid and Medicare Advantage markets across the U.S., Avēsis, a Guardian company, maintains a national perspective on industry changes that can improve care for your enrollees and the providers in our networks. This includes closely monitoring and advocating for the development of state-level regulatory changes to make access to telehealth services more accessible, particularly for people living in health professions shortage areas or with other network access concerns.
One market where we’ve helped expand access to telehealth is Kentucky. Under the leadership of our Associate National Dental Director and Kentucky State Dental Director, Dr. Jerry Caudill, we helped shape the development of Kentucky’s 2019 SB112: An Act relating to telehealth to include both synchronous and asynchronous modalities for dental care. After restrictions were proposed, we collaborated with industry partners to help elected and appointed officials understand the potential impact of the restrictions on the Commonwealth’s most vulnerable members. These efforts contributed to the passage of the legislation. As the regulatory landscape changes, we will continue to monitor and advocate for state regulatory requirements that help ensure all your enrollees have convenient access to high-quality care, particularly those living in provider deserts.
Whether it’s through telehealth or trauma-informed care, Avēsis and Guardian are always leading the way for our clients and their enrollees. Our innovative programs help expand access to those who face hardships when navigating their own healthcare due to transportation, connectivity, or other SDoH issues.
We’re here to help. Contact us to learn the many ways we bring healthcare home.