Insurance implications of the rapid adoption of telemedicine
Several liability exposures are likely to arise in light of the rapid adoption of telemedicine during the COVID-19 pandemic.
COVID-19 has provided a huge external shock to many industries, but maybe none more so than health care. The pandemic has prompted a reckoning throughout the world’s healthcare infrastructure, shattering decades-old assumptions about how treatments should be offered. This, in turn, is challenging the relevance of the decades-old insurance solutions that health care providers have traditionally turned to.
The imposition of strict social distancing requirements, especially within traditional brick-and-mortar health care practices, has caused a massive acceleration in the use of telehealth.
In the last six months, health insurers and systems have made a strong push for patients who have milder symptoms to transition to telehealth platforms to help alleviate the strain on emergency rooms and doctors’ offices. This has resulted in telehealth providers such as Teladoc Health, Inc., reporting a spike in video requests to more than 15,000 per day in the month of March. On this trajectory, virtual care interactions in the United States are on pace to top one billion by the year’s end.
Many health care systems across the globe have been inching towards making more services available via telehealth for years. But now, many experts believe that the pandemic has pushed the inevitable telemedicine revolution forward by a decade. These strides have prompted many governments, payers and providers to double down on the digital revolution gains within health care.
Telemedicine is not perfect, and there are certain weaknesses and limitations of this model that also have been highlighted during the pandemic. For example, certain illnesses cannot be diagnosed electronically. Take, for example, simple check-ups. These can only partly be done digitally compared to an in-person visit. Certain diseases also do not wait for pandemics to pass. Cancer sufferers have had their treatments delayed, and unfortunately, we do not know yet know the greater impact this will have.
As we look to the future, despite its imperfections, many expect the use of telemedicine services to become even more mainstream throughout the next 12 to 18 months, as concerns about COVID-19 remain until a vaccine is widely available. During this period, consumers’ preferences for care access will continue to evolve, and telehealth could become more deeply embedded in the care delivery system.
Liability issues to consider
From an insurance standpoint, there is a myriad of emerging liability exposures that will undoubtedly arise from the COVID-19 pandemic and the rapid adoption of telemedicine solutions.
Assistance across state lines has been a key theme of the pandemic as health care professionals have been offering services outside of their normal jurisdiction or scope. Whilst the normal restrictions have been temporarily loosened, in the long term, this could become a key issue with many insurance products having tight geographical limitations.
Opioid prescribing and telemedicine are the two top regulatory issues cited by state medical boards, according to a new survey. This brings a strong expectation from insurers that a wave of medical board investigations is expected as providers continue to grapple with the complex web of federal and state regulations for telehealth.
An understandable amount of confusion also remains over privacy and security risks. Health care providers and systems have rapidly rolled out technologies to provide broader access to care, sometimes neglecting security in the process.
Things like iPads and other mobile devices are being used to run a remote-triage tent. We have also seen a relaxation of firewall rules to accommodate additional remote-work capabilities as a possible danger.
A U.K.-based telehealth provider recently experienced a breach of its platform that allowed patients to view appointments of other patients. This prompted privacy commissioners as far as Alberta in Canada to investigate the company.
We are also seeing traditional providers struggling to adhere to basic compliance requirements. It is common for many networks and providers to not have physical cybersecurity in place, and things like end-to-end encryption might not be common practice. New entrants also may not understand certain safeguards to protect sensitive patient information during a consult at home.
As you would expect, a rapid adoption to an electronic model will increase the attack surfaces for hackers and the subsequent risk. It also increases the risk of technology failure for providers, which could lead to patient harm. Cybercriminals have quickly sensed these vulnerabilities, looking to launch malware to paralyze health care providers due to their new-found reliance on online tools to operate.
Providers who are now offering services that do not mirror those originally disclosed to insurers could also experience denied claims due to exclusions or a lack of affirmative coverage. Many traditional insurers will cite a litany of limitations within their policy forms that were constructed in a time when telemedicine wasn’t widely adopted or its risks well-understood.
Traditional solutions are built for traditional providers, and many existing solutions are rigid in their scope and terms and conditions. Purchasing adequate protection from insurers who have a solid grasp on emerging exposures has never been more important. This new wave of emerging risks has been magnified during the pandemic and now calls for a revolutionary approach from the insurance community to ensure these uncertainties are affirmatively addressed and brokers can access the solutions their health care clients desperately need.
Tim Boyce (tboyce@cfcunderwriting.com) is the health care practice leader at CFC Underwriting, a London-based specialty insurance provider. With over a decade’s experience of underwriting health care risks, Tim pioneered the development of CFC’s package policy tailored to the unique risk profile of companies operating at the intersection of health care and technology.
If you want to learn more about telemedicine, check out this new title from National Underwriter: Telemedicine Facts. This eBook provides an in-depth look at the administrative and regulatory requirements for telemedicine operations in government health insurance programs (Medicare/Medicaid) and private health insurance plans.
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