Telehealth Extension

Kyle Zebley  0:03  
We are taking advantage of this now. Telehealth is working for us. It's part of our care plan. It's something I want to have. It's something I want my loved ones to have. It's something that I don't want to go away. Let's make sure our healthcare system remains firmly entrenched in the 21st century. 

Terry Wilcox  0:21  
This week on the patient's rising podcast continued patient access to telehealth services after the pandemic, Kyle Zebley at the American Telemedicine Association shares a policy update and what to expect. Welcome to the Patients Rising Podcast. I'm your host Terry Wilcox, CEO of Patients Rising. I'm joined by my co host back from from the fiance renaissance movie premiere in London. He's Bob Goldberg, co founder of the Center for Medicine in the Public Interest. Now, Bob, where's your red carpet picture with Bae Bae? 

Bob Goldberg  0:56  
Bae is her nickname. You know, Baeonyce and it's not Beyonce is Baeyonce? Yeah, no, I sent you a photo of me and Beyonce together.

Terry Wilcox  1:08  
Yes, you did. Yeah. Now, Bob, these are two different photos. One of Beyonce on the red carpet or Bae, as you call her. And your photo, your photo? Looks like a mugshot.

Bob Goldberg  1:23  
Okay, I can explain. All right. I did try to get a red carpet pic with Bae. And I did step on the red carpet. And that kind of explains the mugshot. And I listened. I told her people and MI5, which is the British Secret Service that I was on assignment for Patients Rising, but didn't buy it. So I got to say, you know, all things work out in the end. Thanks for bailing me out. I know it was pricey, but I hope it was worth it. 

Terry Wilcox  1:52  
Every penny Bob every penny.

Bob Goldberg  1:55  
Well, that's a good segue because speaking of pricey on today's show US Senators call for an investigation into high drug prices due to shady practices by insurance companies. And speaking of insurance companies, two of the biggest health insurance conglomerates could be merging to form a mega conglomerate. 

Terry Wilcox  2:16  
Another one. My first one of the only good things that came out of the pandemic for patients was the ability to have a healthcare appointment through telehealth. This did show much for patients it gave high risk patients the ability to see their provider but stay out of a doctor's office and see specialists that they otherwise wouldn't even have access to. Plus providers say telehealth gives them the opportunity to see the patient's environment and family, which helps them give those things consideration when formulating a treatment plan. It makes sense we should be able to keep telehealth now post pandemic, don't you think Bob? 

Bob Goldberg  2:54  
Yeah, and we proved during the pandemic that it worked and especially as you pointed out chronic diseases and helped improve continuity of care, went a long way to addressing and solving some of the systemic disparities of health care for such as for patients in rural areas. But, you know, it's not so easy when we're talking about the government in terms of getting this memorialized in law. So we turn to Kyle Zebley, who is the Senior Vice President of Public Policy for the American Telemedicine Association. So we asked Kyle, where we are on telehealth legislation and how it affects telehealth practices at the years end. 

Kyle Zebley  3:39  
At the federal level, pretty much everything that was put in place, largely on a temporary basis early in the pandemic, in terms of Medicare, geographic and originating site waivers in terms of ability for folks to access care through High Deductible Health Plans, innovative models, like acute hospital care at home, the ability of providers to prescribe clinically appropriate controlled substances via telehealth to patients, those are all still in effect, even with the end of the COVID-19 public health emergency. And they're in effect either because of legislative action by Congress, or regulatory action by various agencies. And actually, interestingly, they all expire, by the way the end of 2024 which means that we're setting ourselves up for a telehealth Super Bowl of sorts next year at the federal level. At the state level, all those no state has the exact same telehealth laws as they did at the outset of the pandemic. They've all significantly opened up and their access to telehealth and have removed pre existing barriers, most of them on a permanent basis, almost entirely in the positive direction. But that's still a much more fluid environment and a much more diverse environment. Because there's so much variation from state to state.

Terry Wilcox  4:56  
Telehealth is, is great. I mean, Bob, you and I both have probably used telehealth on several occasions even for ourselves. I know, I think I have a telehealth appointment in a month. 

Bob Goldberg  5:09  
It really has been transformational and will continue to be so you know, listen to it our core in a Patients Rising is patient advocacy education, main mission with the show and other patient rising channels is to make sure people know what legislation is out there and how it's going to affect them. So telehealth is a big one. And here's Kyle on what to follow regarding telehealth right now.

Kyle Zebley  5:38  
So we've got all the right bills in place to make permanent the favorable policies that have come about during the pandemic bills to make the Medicare flexibilities permanent bills that would make permanent this high deductible health plan tax policy plan that was put in place early in the pandemic, that's still in effect now. I think the leading bill, for instance, that would make the Medicare flexibilities permanent is one that's been reintroduced many Congress's running called the Connect for Health Act, which is a bipartisan effort has had super majorities of sponsors in the Senate in the past, which has robust support in the House. But I think it's not even a question of having all the right pieces of legislation. And we largely do have that. It's a question of making sure that we're lining things up so that when push comes to shove, and we're getting closer and closer to the end of next year, when so many of these flexibilities by legislation expire on New Year's Eve 2024. It's about lining up our support with our broad base of bipartisan champions on Capitol Hill.

Bob Goldberg  6:42  
I would say that telehealth is bipartisan, just as many other issues that Patients Rising deals with is addressed in a bipartisan fashion. The problem is just moving the policy along because of all the other dysfunction, and grandstanding that takes away from the actual work of legislation. 

Terry Wilcox  7:07  
Which is always tough to do. I mean, that's one of the things that you don't see in Congress now as much as perhaps in the past is actual legislation and the work of the people really happening. We asked Kyle, so if this is a bipartisan issue, why hasn't it been done already? 

Kyle Zebley  7:27  
I think our biggest obstacle is dysfunction. And I think that it's not the fault of Republicans, Democrats, it's the total fault of Republicans and Democrats. It's just how our Congress has evolved over the decades to make it very difficult to do basic things. And that means keeping the lights on, for instance, not shutting down the government. Again, I'm not trying to make a political accusation against anybody. It's just the God's honest truth, that it is very difficult to do the hard work of going through regular order or something close to it, and come up with a new standalone bill that gets signed into law. And so therefore, because of the dysfunctionality, there ends up being a lot of movements towards the path of least resistance. And that means not allowing good things to go away in terms of policies that have been put in place, but instead, kicking the can oftentimes, and so that's happened a number of times with these flexibilities. And that's why we're now at a place where they've been temporarily extended.

Wow, you know, we hear this time and again, that Congress is having a hard time passing good bills. It does seem everyone agrees on that one particular issue because of the polarization. So must pass or spending bills are essentially the only place to stick legislation at this point to get it moved. But I would argue, Bob, with our new Speaker of the House, and this sort of world that he has to balance with both sides of the Republican Party, it's even hard to do like omnibus must pass bills, like, don't you agree? I mean, they're having to put things through one at a time in order to Yeah, keep everyone together. 

Bob Goldberg  9:20  
Yeah, I mean, the risk of putting on my old political science, professor hat, Congress, like the society around it has become much to move, everything moves faster, it's much more fractionalized. The way of building support is to grandstand as opposed to build coalitions most of the time, but in other any arguments against it that patients should address. Here's a Kyle with an answer to that. 

Kyle Zebley  9:50  
There are legitimate questions that advocates patients, citizens must be prepared to speak to when they come up. This idea that telehealth won't be a budget buster. It hasn't proven so thus far, it hasn't led to a huge explosion of over utilization. It's largely been care in lieu of what would have been care in person or its care that would have been unmet.

Terry Wilcox  10:15  
Well, of course, we are also an organization that empowers patients to advocate for themselves. And we have a huge role in this effort to make sure telehealth will be here to stay. We ask Kyle, what patients and patient advocates can do to help? 

Kyle Zebley  10:31  
Well, by letting their state policymakers their state legislators and regulators and folks in the executive branch at the state level know that they want to break down Interstate barriers to care get more options through allowing virtual only providers and out of state state providers to take the full advantage of telehealth and give more clinically appropriate options to them. And then, of course, to talk to their member of Congress, their senator, send a note to the Biden administration or respond to comment periods and there's always lots of them for various rulemaking agencies at the federal level and say, we are taking advantage of this now, this is telehealth is working for us. It's part of our care plan. It's something I want to have. It's something I want my loved ones to have. It's something that I don't want to go away. Let's make sure our healthcare system remains firmly entrenched in the 21st century, that we don't go sliding backwards to the bad old days as they existed in terms of the restrictions prior to the onset of the pandemic.

Terry Wilcox  11:34  
Well, it's definitely Bob, you and I both know this, it's time to stop sitting around and reflecting on the lessons learned from the pandemic now that we're a good distance out of it and move forward and keep telehealth. Absolutely. And our audience can learn more about Kyle's work at the American Telemedicine Association by using the link in the show notes.

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Bob Goldberg  12:42  
Now, Terry, before we go today, we should talk about one or two of the bigger stories in the news that came across our desks that will definitely impact patients. Now the first up is news that Cigna and Humana are exploring a merger. So apart from the name change, what does this mean, for patients? Terry? I'm thinking of Hucigna, or Signana. I don't know, cigma?

Unknown Speaker  13:19  
Well, you know, Humana has a huge footprint. I know this because it's in my house, Medicare Advantage, Medicare Advantage space. They're calling this a blockbuster deal. I am skeptical given it is early December. And it could be done by the end of the year. But that's what they say. 

Bob Goldberg  13:40  
You know that there's two things First, it's a way of grabbing market share, like every other company in every other industry. And there's going to be problems with integration. But the bottom line is, it's a ready source, but thanks to the PBM business that Cigna has, which Humana doesn't, that's a huge amount of cash. So I think you're right, I don't think it's going to be done by the end of December. 

Terry Wilcox  14:08  
One of the things that I think I see here, when you look at this potential Cigna Humana merger, and then you look at the recent news that CVS has come out with saying, we're going to be more transparent at the pharmacy counter in a nutshell. I mean, there's a little more read into it than that. But basically, the goal is we're going to be more transparent and patients aren't going to get paid on all the shenanigans that go on in the black box that nobody can read, which is always what patients rising has been advocating for. Look, organizationally we are for all the things as long as it creates choices for patients that are affordable, transparent, and provide the access that patients need. Another development we are following is an unlikely couple of senators who have teamed up, senators Elizabeth Warren from Massachusetts and Mike Braun from Indiana, have called on the HHS inspector general to investigate the role health insurers play in high drug prices. Because in the cases of these big companies, they also have ownership of the pharmacies. The stories are all here, we just had this very positive story about the transformation that is possible with transparency and opening things up. And then this is sort of an investigation into the history of the dirty underbelly of it all.

Bob Goldberg  15:32  
Yeah. Well, you know, look, like you said, the change is fast, but incremental. So you still have the holdover examples of what not to do. And my friend Susie, who is on a drug for colitis, to generic drug, she was in the coverage gap. And lo and behold, her health plan charged her for a generic drug for a 90 day supply $732. So, you know, she came to me, and I said, don't worry, I've got Mark Cuban on speed dial actually, I have Mark Cuban cost plus pharmacy on speed dial, go to Cubans pharmacy, same pill 90 day supply $122. Yeah. So that's why transparency is so darn important. 

Terry Wilcox  16:21  
No I mean it's crazy what they do. And this is a story that's very, we've been talking about this story since before the Wall Street Journal article reported on it. But, you know, many companies have put out and this goes all the way back to, you know, several years ago, when this first started happening, where companies would put out a lower cost, branded generic version of their drug to give a lower cost option without all the rebates attached, right? But that's not what they would choose to pay. They would say nobody wanted to buy the lower cost version, right? They all wanted to buy the higher cost version. And then they were still billing patients on the haha list price of the drug. Which is one of the things that this CBS plan alleges to want to solve that that's what they don't want to do. 

Bob Goldberg  17:07  
Well, it goes back to you know, it's what you pay at the checkout counter, not the price. 

Terry Wilcox  17:12  
It's what you pay at the checkout counter that matters to patients. It's all well and good you can talk about the list prices, and I know everybody's like, but Medicare pays on this price and this. But see, that's the thing, you shouldn't be you know, there should be a system a world in which patients are not the ones while everybody else is getting rebates and getting fat in the middle, patients are the one left holding the bag. So we'll have links to the stories in the show notes. 

Bob Goldberg  17:37  
And we have lots of great things planned for 2020 for an advocacy and on the show. So we will meet you right back here next Monday. Make sure to follow us on your favorite podcast app so you can be notified bright when it airs. 

Terry Wilcox  17:54  
Until then, for Bob and everyone at patients rising. I'm Terry Wilcox, stay healthy.