THE CHALLENGE:
During the COVID-19 pandemic, a public health emergency (PHE) was declared. Related legislation and regulatory action temporarily loosened restrictions on virtual care and telehealth services to ensure continued access to care in a safe manner for patients and providers.
Increased access to affordable telehealth services benefited patients and providers, but without extensions of the relevant waivers, the flexibilities were set to end. If they did, the restrictions would take effect again.
OUR OBJECTIVE:
The M+ team, led by Rachel Stauffer, noticed several key gaps in the policy conversation. They aimed to leverage those insights to lobby for legislation and regulation to extend the telehealth waivers. To begin this advocacy work, the team formed two separate and distinct coalitions to bring together providers and industry players in the telehealth space.
The Advanced Care at Home (ACAH) Coalition focused on ensuring that the Acute Care at Home waiver, which gives beneficiaries greater flexibility to access hospital services at home, was extended beyond the end of the PHE.
The Partnership to Advance Virtual Care (PAVC) Coalition has a broad mission to increase access to virtual care. In this instance, the coalition advocated to extend a waiver allowing eligible beneficiaries with certain high-deductible health plans (HDHPs) to access telehealth services—including behavioral/mental health services—pre-deductible. M+ research revealed that the waiver was especially critical to providing affordable mental healthcare to lower-income Americans. The waiver was set to end December 31, 2022.
THE OUTCOME:
Together with other like-minded stakeholders, M+ secured extensions of the flexibilities targeted by the ACAH and PAVC coalitions, giving beneficiaries continued access to affordable virtual care and in-home services. Both waivers were included in the Consolidated Appropriations Act of 2023, with two-year extensions through December 31, 2024.
DIG DEEPER:
Drawing on more than a decade of experience in coalition-building and advocacy work, M+ nurtured broad, deep relationships with coalition members and legislators on the Hill to drive target priorities.
The team harnessed the collective power of the ACAH and PAVC coalitions to innovate thought leadership strategies. They also used the M+ team’s strong data capabilities to analyze the policy landscape and accurately identify how to bring their unique skillsets to bear on the issues and achieve victory.
Advanced Care at Home
The ACAH coalition and other partners secured an extension to the Acute Care at Home waiver as a bridge to a more permanent policy following the end of the PHE. The two-year extension provides a level of certainty to hospitals with existing in-home care programs, along with those exploring the possibility of beginning programs, while stakeholders and policymakers determine how to structure a permanent policy.
When the coalition began lobbying for legislation to extend the Acute Care at Home waiver, it faced an uphill battle. Because hospital at home programs are all tailored to their local patient populations, gathering similarly measured outcomes and data was a challenge.
The M+ team developed a strategy to drive the message of the programs’ value while continuing to work on standardizing and collecting data. In collaboration with coalition members, the team anecdotally highlighted hospital at home programs and the value they brought to communities, patients and providers. The team also innovated thought leadership programs, including a “week of action” around hospital at home: Throughout the week, using daily themes, they shared patient and provider stories and hosted panels, webinars and virtual sessions. The week culminated in a day on the Hill to educate Congressional staffers through hands-on demonstrations.
With an eye to the future, M+ and coalition members also led an effort to develop a quality framework for the program to assess the quality of care being provided to patients in hospital at home programs. This work was shared with Congress and the Administration to help inform policymakers and guide conversations around quality in a future acute care at home model.
Partnership to Advance Virtual Care
In partnership with other organizations, PAVC’s work in extending the HDHP provision for two additional years (through December 31, 2024) was significant in ensuring continued access for both primary care and behavioral/mental health services in a virtual care setting. The extension provides a degree of certainty to plans and providers in scheduling out services for eligible beneficiaries.
The coalition brought a variety of stakeholders together to advocate for an extension of the waiver. The team coordinated with other stakeholder groups, including plans, employers, beneficiaries, providers, vendors and tech companies, navigating competing priorities in the telehealth space to draw attention to the HDHP issue. The M+ team’s advocacy work shifted the narrative around the waiver, spotlighting the impact of access to behavioral/mental health services and the way the policy benefits recipients. As a key consideration for Congress, the team drew attention to barriers faced by patients seeking behavioral/mental healthcare. Specifically, they worked to highlight that out-of-pocket, up-front costs for a behavioral/mental health telehealth visit can cost roughly 15 times more than a primary care telehealth visit, making it a financial trade-off for HDHP beneficiaries to access those services regularly and benefit from them pre-deductible.
The M+ team also harnessed their data analytics capabilities by launching a “Telehealth Tuesday” series. Through this platform, the M+ team spotlighted publicly available Medicare data to underscore how patients and providers were utilizing and benefiting from access to virtual care. This helped inform policymakers on the importance of extending telehealth flexibilities.
Linking data and policy with the unique skillsets of M+ , the team was able to leverage the ACAH and PAVC coalitions and work with stakeholders to drive progress and extend the target telehealth flexibilities for two years.
Learn more about the M+ Health Advocacy, Policy & Lobbying Strategies.