The new landscape for telehealth is revealing itself as the COVID-19 pandemic gradually winds down. Existing players are striving to differentiate themselves in an increasingly crowded market, and Amazon.com, Inc. is rolling out a big bet on telehealth and in-home care.

Health insurers on the Affordable Care Act (ACA) exchanges are consistently overestimating the amount they spend on enrollee benefits as part of their medical loss ratio (MLR) reporting, resulting in “hundreds of millions of dollars in underpaid policyholder rebates,” according to new research. Health policy experts tell AIS Health that the findings could fuel greater regulatory scrutiny on individual market carriers, which are increasingly making a profit on the exchanges and had to shell out less than usual in claims last year due to routine-care deferral during the COVID-19 pandemic.

A bundled payment program run by San Francisco-based digital health company Carrum Health resulted in an average per-episode savings of more than $16,000 per orthopedic or surgical procedure performed by a provider in the bundled program, a RAND Corp. analysis found.

Orange, Calif.-based Alignment Healthcare, Inc. just became the third startup insurer in recent months to go public. Banking on the strong value proposition of Medicare Advantage, Alignment said it already has a “national expansion strategy” that it will put into action next year, but some experts question whether the measured growth the insurer has achieved primarily in California can be duplicated in other markets. The insurer on March 25 announced the initial public offering of 27.2 million shares of its common stock at $18 per share and on March 26 was expected to begin trading on the Nasdaq Global Select Market under the symbol “ALHC.”

by Jinghong Chen
The telehealth boom caused by the COVID-19 pandemic has led policymakers to make an array of changes to telehealth regulation and payment structure. As of February 2021, 43 states and Washington D.C. have a law addressing commercial health plan coverage of telehealth services, according to Foley & Lardner’s 2021 50 State Survey of Telehealth Commercial Insurance Laws. Still, only 22 states maintain laws expressly addressing payment and reimbursement rates for telehealth, with 14 of them offering reimbursement parity relative to in person clinical care. In addition, the survey reports that coverage of store-and-forward telehealth and remote patient monitoring services has grown.