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Beginning April 1, 2025, Medicare beneficiaries could face reduced telehealth coverage as the temporary flexibilities introduced during the COVID-19 pandemic expire, unless extensions are approved. These waivers, which allowed expanded access to telehealth services, will no longer be in effect. This shift could lead to access challenges for Medicare beneficiaries, especially those in rural or underserved areas.
A decline in telehealth services could lower beneficiary satisfaction, reduce access to care, significantly impacting key CAHPS measures, hinder gap closure efforts and ultimately overall Star Ratings in some cases.
Impact to Star Ratings
Telehealth Services and HEDIS Performance
The reduction of telehealth coverage for Medicare beneficiaries would directly impact a beneficiaries’ access to care, making it harder for health plans to manage their health. This could lead to delayed chronic condition management and inadequate follow up care, all of which could lower Medicare Star ratings due to poor HEDIS performance. Without telehealth, many beneficiaries may face difficulty accessing these services, leading to unaddressed care gaps and lower performance across multiple HEDIS measures.
Beneficiary Experience CAHPs Impacts
The elimination of telehealth services could potentially lead to beneficiary dissatisfaction and ultimately negatively impact a plan’s overall CAHPs rating due to the following reasons:
- Loss of Convenience, Flexibility and Accessibility: Telehealth has provided beneficiaries with flexible, convenient care regardless of location. Its removal forces in-person visits, which may be inaccessible due to distance, transportation, finances, work, caregiving or other barriers.
- Longer Wait Times and Delays: Without telehealth, provider availability may become more limited, resulting in longer wait times for appointments. This can cause frustration among beneficiaries seeking timely medical attention.
- Quality of Care Perceptions: Beneficiaries who turned to telehealth for routine care, follow up appointments and chronic condition management may feel their care has been downgraded, reducing their satisfaction with the health plan.
Actions for Health Plans to Take Today
- Scenario Modeling: Health plans should assess the number of beneficiaries relying on telehealth services to close gaps in HEDIS measures. Gaps that were not closed already may not be closed during the remainder of the year and therefore multiple scenarios should be developed for assessing risk.
- Outreach to Impacted Beneficiaries: Health plans should identify beneficiaries who have used telehealth services and proactively reach out to inform them of the upcoming changes. Additionally, they should support beneficiaries in finding alternative care options that best meet their individual needs.
While there is a possibility that the legislation will be extended and telehealth access will continue, it is essential to fully understand the potential implications for your plan. Being proactive and strategically preparing for any changes will ensure you can adapt smoothly and make informed decisions with confidence.
DISCLAIMER:
There are currently drafted continuing resolutions to extend waivers through the end of September 2025. If the extension is not approved, certain exceptions will still allow Medicare members to access telehealth, including those based on geographic location and behavioral health needs.
How ProspHire Can Help
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