Expansion via Telehealth: How to Reach Patients in New Geographies

Anytime a new technology or business practice is introduced, some organizations will struggle to effectively adopt it – while others will recognize the potential for growth these new opportunities present. Telehealth is no exception. As the most forward-looking practice groups, MSOs, and other healthcare organizations have already begun to realize, telehealth provides an ideal solution not just for providing care to existing patients – but for acquiring new patients in new geographies, as well.

As telehealth has surged in both popularity and prevalence, these organizations have begun leveraging it as a vehicle to expand across state lines – and even international borders. But as with any new technology or business practice, geographic expansion via telehealth requires a disciplined decision-making process, and a sound business strategy. Here are the elements of an effective, actionable plan for geographic expansion via telehealth.

1. Determine if You Are Practicing Telehealth in an Interstate Medical Licensure Compact (IMLC) State.

Since 2013, the IMLC Commission (IMLCC) has been working with the Federation of State Medical Boards (FSMB) to create cooperation between states, whereby member states accept the licensure of physicians licensed in other states. To date, 29 states have signed on to this compact. Therefore, if you are currently licensed and practicing in an IMLC state, it’s easier to practice telehealth in other IMLC member states (provided you pay the other states’ licensing fees).

The unfortunate part is that the 31 states which are not yet part of the IMLC include New York, California, Texas, Florida, Connecticut, and Massachusetts, among other high-population states.

Areas of present opportunity include the upper Midwest, where high-population states such as Illinois, Wisconsin, Minnesota and Michigan are members of the IMLC. Many contiguous Great Plains and Rocky Mountain states, as well as a band of Southern states, are also IMLC members, creating opportunity for practices in those regions. The full list of IMLC member states can be found here.

Many IMLC advocates are looking to New York state as the next big domino to fall into the IMLC agreement. In 2020, legislation to approve IMLC membership for New York was introduced in the New York State Senate.

Determining your IMLC eligibility is a big first step in a potential telehealth expansion plan – if you can take advantage of the IMLC, that removes many obstacles to your interstate expansion goals. If not, it becomes more complicated, as you will have to explore whether you can gain licensure in the states into which you want to expand.

2. Meet With Your Keane Agent to Discuss your Interstate Medical Practice Expansion Plans.

Once you have established a potential vision for your interstate expansion via telehealth, bring in your Professional Liability Insurance / Malpractice Insurance provider, and discuss your plans with them. The key reason for this step is that just because the IMLC may allow you to practice in another IMLC member state, that doesn’t mean your insurance provider will provide the same coverage as in your home state – or provide any coverage at all.

3. Analyze the Landscape of Private Payers in the States Into Which you Want to Practice Telehealth.

Every state is different in terms of who the private payers are. Blue Cross licensees may represent a substantial segment of private payers in any state, but nevertheless, an analysis of who will be reimbursing you, and what new relationships need to be established (and requirements will need to be met) is a prudent evaluation, as it will represent a new line of work for your billers and coders.

4. Outline a “Phase 1 / Beta” Plan as a Proof of Concept and Learning Phase for Your Business.

Once you have completed the above three steps to your satisfaction and business viability, then you will need to think about how best to launch your interstate expansion plan.

As with any fundamentally new paradigm, it is often best to “crawl before you walk,” to test your ideas and undergo learning opportunities to validate your future broader vision. In the case of geographic expansion across state lines, logic dictates certain patient population segments as “Phase 1 / Beta” targets. These may include:

  • Current/former patients who have moved to another state. An example would be a Chicago-area practice which has patients that have retired to Arizona. As both Illinois and Arizona are member states of the IMLC, a continuing relationship through telemedicine is not blocked by interstate licensing requirements.
  • Specialty and sub-specialty practices who can serve rural areas (or areas underserved by local specialists and sub-specialists) in nearby states. For example, a pre-eminent sub-specialist in the Atlanta metroplex can consult with and treat patients in states such as Alabama, Tennessee, Kentucky, or Mississippi, which are all members of the IMLC along with Georgia. In this case, marketing and building referral sources would be key. An advantage of relative proximity is that patients who can be consulted with via telehealth have a reasonable opportunity to come to the practice’s location physically if/as special needs arise.

Addendum: What about International Expansion via Telehealth?

The sudden and explosive growth of telehealth in 2020 has raised a new set of prospects – namely, the expansion of practices, groups, and provider MSOs not only to other states, but to other countries.

Although most Western European countries (and Canada) have free national healthcare provided to their citizen taxpayers, creative thought can carve out a couple intriguing areas of opportunity using telehealth.

One is foreign patients for especially renowned US practitioners. Foreign patients of greater wealth and means can choose a US practitioner, if they want to foot their own bill. This could be food for thought for well-known, top-of-field US doctors with a national (and potentially global) referral reputation.

Another opportunity is US citizens who are living or frequently travel abroad, and have US-based health insurance with an international rider. While not common, there is a subset of corporate employers who add various forms of international coverage to protect their employees while abroad. Thus, a US-licensed provider can treat your patients while they are abroad, and be reimbursed by their US-based private payer. Although perhaps a small subset of patients, this nevertheless represents a patient population for which telehealth uniquely enables international treatment, and can include your own current/past patients as well as new patients (acquired through targeted marketing to corporate employers and/or referrals from insurance company private payer relationships).

Of course, there is a complex matrix of considerations, opportunities, and limiting factors to this concept. From a regulatory and liability standpoint, international telemedicine is still in initial phases.

Keane Insurance Can Help

As you can see, the possibilities of geographic expansion for your practice, practice group, or MSO via telemedicine are numerous. At the same time, there is a dense set of practical, technical, and regulatory considerations that need to be examined and addressed to move forward into this new frontier.

As you can see, the possibilities of geographic expansion for your practice, practice group, or MSO via telemedicine are numerous. At the same time, there is a dense set of practical, technical, and regulatory considerations that need to be examined and addressed to move forward into this new frontier.

Contact your Keane agent today regarding telehealth – both in terms of MPL coverage, as well as telehealth training and consulting services available to help you increase your revenue, grow your practice, and keep your organization viable as telehealth continues to change the landscape of healthcare.

Upcoming Telehealth Webinar

For more information, be sure to register for our upcoming webinar: “Telehealth: 2020 Lessons Learned, 2021 Opportunities Ahead” with healthcare consulting firm Medical Advantage, set to broadcast on May 18th, 19th, and 21st.  We’ll give examples of providers who’ve made effective use of telehealth technology to engage patients and maintain visit volumes.  We’ll also discuss telehealth as a revenue growth opportunity in 2021 and beyond.

This blog is adapted from a post which originally appeared on medicaladvantage.com.