Originally published in Managed Healthcare Executive
Dr. Stephen Ondra
Telehealth solutions are here to stay.
The spread of COVID-19 has caused an explosion in telehealth consultation and is catalyzing the use of remote patient monitoring (RPM) thanks to an acceleration of reimbursement from commercial and government health insurers (payers) during the pandemic.
Look no further than statistics from the Centers for Medicare & Medicaid Services (CMS) that show telehealth visits during the pandemic surpassed 11 million through mid-September of this year.
Before CMS expanded coverage of telehealth for seniors in late March, there were about 15,000 Medicare beneficiaries a week with a “telemedicine visit.” The agency defines telemedicine as “Medicare telehealth, audio-only evaluation and management visits, virtual check-ins or e-visits.” Most of these visits were from rural areas before telehealth coverage was broadened as COVID-19 spread in the U.S. in March.
“These changes allow seniors to communicate with their doctors without having to travel to a healthcare facility so that they can limit risk of exposure and spread of this virus,” CMS administrator Seema Verma said in March. “Clinicians on the frontlines will now have greater flexibility to safely treat our beneficiaries.”
CMS changes to allow broader coverage has led to an explosion of Medicare telehealth usage — with more than 1.6 million visits to providers by early April to more than 1.8 million a week by May. As COVID-19 spread across the U.S., policymakers realized the importance of remote medical care, which became lifesaving for millions of Americans that were unable to see a physician or have an in-person clinic visit during state shelter-in-place orders.
A Positive Paradigm Shift
This coverage will only continue to escalate as patients and providers become more comfortable with telehealth and RPM technology. In doing so, it’s poised to improve the options for patients to access and receive care in ways that are often more convenient and efficient for them. As welcome as this long overdue change is, televisits or e-visits are simply a virtual version of the current reactive paradigm of care delivery; patients get sick and then seek care.
As such, telehealth alone will also only marginally address the challenges of provider shortages and care access. To address these growing concerns, next generation technology developments will further enable a paradigm shift that can transform the care delivery model into one that is more focused, efficient and proactive. For example, continuous remote patient monitoring (cRPM) solutions allow us to more efficiently target care resources as early as possible to where they are needed. The ability to identify patients early in the course of an illness, often before the patient is even aware of a deterioration, can allow providers to take action to prevent a more serious illness. This is particularly important to the 5% of often chronic conditions that drive 50% of healthcare cost.
Like telehealth, the use of advanced RPM and other technology has been slowed by a lack of reimbursement-incentive alignment. Now that Medicare’s fee-for-service program is covering telehealth, its use along with complementary technology like cRPM will continue to grow. This trend will accelerate as payers move away from traditional fee-for-service, volume-based care to value-based approaches that reimburse based on medical care provided in the right place, at the right time and in the right amount.
This shift has long been discussed and, despite the promise, change has been glacially slow yet steady. Once again, COVID-19 is catalyzing this transition, as providers have been financially stressed and are more actively considering alternative payment models. At the same time, health insurers are expanding their incentives in the area of value-based reimbursement.
Take UnitedHealthcare, the nation’s largest health insurance company, as one example.
The company, which works with more than 110,000 U.S. physicians and 1,200 hospitals, now has more than 1,250 accountable care programs, which the insurer says pay more than $80 billion annually to providers via value-based contracts. UnitedHealthcare says the value of these contracts is 45% — nearly half — of the company’s annual medical spend.
The effort by UnitedHealthcare mirrors that of other payers like Cigna, Anthem, the Aetna unit of CVS Health and Blue Cross and Blue Shield. Across the country, these health plans are shifting at least half — and in some cases much more — reimbursement to alternative payments tied to quality and value. Harnessing paradigm shifting technology will be an important enabler in the shift to value-based reimbursement and the related care models that will improve health outcomes and the care experience, while also saving money through the efficient targeting of care resources.
Moving to a Value-Based Future
Fortunately, technology has advanced to the point where it is possible for it to become an integral part of overall patient care. For example, cRPM is distinct from spot checks of health status, which are often lagging indicators of health status and are thereby limited in providing the proactive actionable insight that cRPM offers to patients and their care teams. By continuously monitoring the physiologic status of at-risk populations, cRPM solutions allow providers to more efficiently focus healthcare resources to where and when they can be most effective in preventing or controlling illness. Such transformative approaches will improve the value and quality of the care patients receive. This will also benefit hospitals, doctors and other healthcare providers who are signing alternative payment models that link reimbursement to improvements in care outcomes and value, rather than simply the volume of services.
As healthcare costs rise and the U.S. has increasingly scarce resources, it’s only a matter of time for such approaches to become an integral part of care delivery. The destabilizing impact of COVID-19, along with unemployment at Depression-era levels and spiraling national debt, will continue to catalyze the move to value-based reimbursement. Telehealth and the use of transformative technologies such as cRPM and other innovations will become part of a cost-effective solution that improves outcomes, saves lives and lowers overall healthcare costs.
Dr. Stephen Ondra is a leader in healthcare delivery, technology, strategy and innovation.