I have been an enthusiastic supporter of telemedicine as a means for hospitals to provide care to more patients without any bricks-and-mortar investment (see: Details of Cleveland Clinic's MyCare Online Virtual Telemedicine Visits; Hospital Telemedicine Provides Opportunity for Pathologists to Interact with Patients). However, progress in this area has been slow. I attribute this to the fact that hospitals and physicians are usually able to innovate rapidly regarding medical science but act more slowly with organizational changes. A recent article addressed the role of health insurance providers in the adoption of telemedicine as a means to expand their provider networks (see: Could Insurers Use Telemedicine to Widen Provider Networks?):
Many states are tightening their [physician] network adequacy standards, and telemedicine might help insurance companies meet those standards, especially in rural and underserved areas, notes a new report sponsored by the Robert Wood Johnson Foundation. But after discussions with insurance executives, state insurance regulators, and healthcare providers in six states, the researchers concluded that most insurers are not yet using telemedicine for this purpose....However, uncertainty about how regulators would perceive this effort, the lack of infrastructure in most practices, and the concerns of organized medicine about telemedicine have inhibited insurers from using this technology to fill gaps in their networks, the report said....Although "virtual visits" that use videoconferencing can occur between physicians and patients at home, the report focused on telemedicine visits that originate in a clinic with a healthcare professional present. The study noted that insurers increasingly favor narrow physician networks to hold down costs, especially in the state insurance exchanges. In response, both federal and state regulators have proposed more robust network adequacy standards at the state level. These new standards include time, distance, and access measures....Starting January 1, 2017, health plans will be able to use telemedicine to help meet the state's criteria for specialty provider-to-covered-person ratios....Neither payers nor providers have invested in the videoconferencing equipment required to set up remote consults between primary care offices and specialty sites. And while providers are increasingly reimbursed for doing remote consults with patients, "there is insufficient penetration [of telemedicine] to make its use practical," insurers told the researchers.....As a result, insurers may not view telemedicine as an economical or practical method to ensure network adequacy."If and when telemedicine becomes mainstream, the report noted, insurers might use it as a bargaining chip with the specialty groups and healthcare systems that dominate some markets.
It seems to me that wider adoption of physician e-visists amounts to a chicken-and-egg challenge. In order for telemedicine to move forward, insurers (1) need to reimburse for the service; (2) hospitals and physicians need to be willing and able to offer such services; and (3) the various state medical boards need to support these initiatives on the part of physicians. There seems to be some progress on this last matter to quote from the Robert Wood Johnson report:
In at least two of our study states...,their medical boards have adopted or are considering approaches that would make it easier for physicians to use telemedicine. For example, in Colorado, the medical board required an initial face-to-face interaction to establish a physician-patient relationship inorder to prescribe medication via telemedicine. Insurers in the state noted that this requirement has inhibited telemedicine from expanding. In August 2015, the medical board changed its position and no longer requires face-to-face encounters.
In general, hospitals tend to be slow adopters of modern IT. This should not be an impediment in the case of telemedicine, however because there third-party vendors can supply such solutions (see: Firm Offering "White Label" Service to Enable Virtual Hospital Physician Office Visits). I personally believe that physician interest and willingness to participate in telemedicine programs is one of the major barriers here.
Cleveland Clinic launched its telemedicine program (Express Care Online) with its family practice physicians who may have been eager to expand their practice and master new ways to interact with patients. As noted above, however, the incentives are for the health insurers is to expand their network of specialty sites.The bottom line here is that health insurance companies need to work in concert with health systems to develop telemedicine initiatives, particularly for medical specialists, coupled with adequate reimbursement for such services.