Editor’s Note: This article by Patricia Kime is part of MOAA’s 2020-21 TRICARE Guide, brought to you by MOAA Insurance Plans, administered by Association Member Benefits Advisors (AMBA). A version of the guide appeared in the November 2020 issue of Military Officer magazine.

Before the COVID-19 outbreak began this year, fewer than 9,000 medical appointments across TRICARE were conducted remotely via telehealth each month.

By April, however, the number had multiplied 35-fold, increasing to more than 301,000 telemedicine visits for the month. By July, they were up to nearly a half million appointments across both the TRICARE East and West Regions.

While telehealth doctor appointments may not be ideal for acute conditions that require physical inspection or diagnostic tests, they have proven their worth for mental health appointments and shown promise for treating some chronic conditions during the pandemic, Capt. Edward Simmer, USN, chief medical officer for the TRICARE Health Plan, told MOAA.

And for some types of medical services, telehealth appointments are likely here to stay, Simmer said, bringing an ease and reliability that may improve medical care and monitoring of chronic conditions in patients.

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“Being able to bring care into the patient’s home is crucial. I think it’s going to improve access to care for a lot of patients, which may help us really address patients with chronic conditions like high blood pressure, diabetes, depression … there’s a lot of hope here,” Simmer said.

New Rules

In early March as COVID-19 infections began spreading across the U.S., medical facilities stayed open, preparing for a potential wave of coronavirus patients and offering regular appointments, but with a significant shift in delivery, with providers encouraging their patients to try telehealth.

The Defense Health Agency (DHA) encouraged patients to call the Nurse Advice Line (1-800- 874-2273, option 1) before making any appointments, and patients, hoping to reduce their chances of exposure to the new illness snatched up opportunities to consult with physicians through secure online portals.

Despite initial delays in March with the Nurse Advice Line, which kept patients on hold for hours, and hiccups with patients logging into telehealth portals for the first time, telephone and video health services appear to be normalizing, gaining a foothold where previously most patients didn’t trod.

According to Simmer, the pre-COVID 30-day telemedicine average was 4,912 in the TRICARE East Region, run by Humana Military, and 3,738 in TRICARE West Region, managed by HealthNet Federal Services.

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By April, those figures shot up to 216,278 for Humana and 84,754 for HealthNet. By July, they were 262,808 and 184,342, respectively.

While patients obviously were choosing to stay home in lieu of venturing out to see a doctor for any non-coronavirus related health condition, DoD also took a number of steps to make telemedicine more appealing to beneficiaries.

In May, DHA eliminated patient copays and cost shares for telehealth options and began covering telephone appointments – a boon to patients who lack the digital skills to log into an online system or who don’t have reliable access to the internet.

Officials also relaxed licensure requirements across state lines for health care providers, giving military family members access to a broader array of providers. Under the temporary reprieve, licensed providers can practice via telehealth to patients outside the their state. For example, in places like Washington, D.C., where the District borders Maryland and Virginia, physicians licensed in Maryland weren’t able to treat their Virginia patients via telehealth before the changes unless the patient drove to Maryland and conducted the visit on a computer in Maryland or on their smart phone.

The changes not only saved patients money, it allowed them to access health care without increasing the likelihood of exposure.

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The switch to telehealth also helped keep civilian health care providers solvent as they saw their patient loads plummet during statewide shutdowns, putting many in financial jeopardy.

“Obviously, we're a little worried about the financial health of our network providers. … There've been a lot of financial constraints and I think telehealth gives them a new way to provide necessary care,” Simmer said.

While these changes have remained in place for much of the year, DHA plans to evaluate whether they should be permanent and will consider telemedicine’s role in the next generation of TRICARE contracts, expected to be awarded in 2021.

Managing Health Care

Simmer said telemedicine shows promise for managing chronic conditions such as mental health disorders and high blood pressure and diabetes with patients receiving regular monitoring at home using their own blood pressure cuffs or glucose meters.

“It may help ensure the continuity and the availability of medical care going forward in ways that we haven't done before. I'm excited about these changes,” Simmer said.

Still, TRICARE officials remain worried that patients are putting off the in-person care they need and he encourages beneficiaries to make appointments for the wellness services and annual tests they may require.

DHA has seen a decline in pediatric patients receiving childhood vaccinations and other routine diagnostic tests, Simmer said.

“We’re very worried about folks missing their needed vaccinations and that has to be done in person, so we are looking at how we can encourage folks to go out there and get those done, especially preventive things like vaccinations, mammography and prostate exams,” Simmer said.

What’s Ahead

While its still too early to tell, the future of medicine may just be a mix of in-person and remote appointments.

“We've done [telehealth] in the military for a long time, for example, we've offered telemedicine just behind the battlefield and that works very well. I think for those things that do not require contact with patients, we're going to see telehealth be a much larger component of care in the future,” Simmer said.

But it won’t be the entire component. The practice of medicine in many cases, requires physical exams, tests, diagnostic services and hands-on treatment and surgeries that can’t be done via a screen.

“There are always going to be people who want to go to the doctor's office and doctors who are always going to want to see patients in person and that's fine,” Simmer said. “It’s all going to depend on the type of care.”

Patricia Kime is a reporter who covers health care issues in the Washington, D.C., area.