By Kellie Rademacher PharmD, VP, Access Experience Team, PRECISIONvalue
Technology has advanced almost as quickly, if not more quickly, than drug development. Not all business sectors have equally adopted this rapid evolution. Healthcare stakeholders, specifically payers and provider practices, often lag behind in their adoption and investment in infrastructure to support evolving technology platforms. Cue the master global disrupter: the COVID-19 pandemic. Business, healthcare, and life as we know it came to a screeching halt. With shelter-in-place orders, business closings, and unprecedented increases in emergency care, change was necessary.
The COVID-19 pandemic thrust payers and providers into adaptation mode in how to deliver care in a predominantly virtual environment. Unsurprisingly, due to the pandemic, reports from payers, providers, and telehealth organizations showed a significant increase in demand for virtual care services over the last few months as compared to previous years.1 Many health plans already offered telehealth services through partnerships with platforms such Tel-A-Doc, CarePaths, eVisit, and Doctor on Demand and had established processes, policies, and training in place, greasing the skids for an easy slide into more virtual care. Conversely, many other provider groups – offered little to no virtual patient care and did not have established processes, policies, or the necessary staff training in place for a seamless shift into the virtual world – were left scrambling to find appropriate vendors to help them deliver care. According to a recent survey by HIMSS Analytics, 31% of healthcare organizations use video-based telemedicine; 34% offer remote patient monitoring; and 44% and 48% of healthcare organizations are eyeing expansion of video-based telemedicine and remote patient monitoring, respectively.1 It remains to be seen to what extent the significant uptake in virtual care offerings and adoption will continue in a post-pandemic environment as there are still several considerations regarding compliance and data security, federal policy, provider reimbursement, and patient outcomes that will need to be fully assessed.
Uncertainty in government and private payer policies is influential in delaying movement for some provider groups and healthcare organizations still on the fence.2 Many private payers have acknowledged that reimbursement for telemedicine is here to stay; however for some plans, the reimbursement rates, which are largely influenced by state parity rate laws, may not align with in-person rates while other plans have committed to providing the same reimbursement rates for telehealth and in-office visits.3 Centers for Medicare & Medicaid Services (CMS) was explicit that support for telemedicine was only “temporary.” Announcements as recent as May 26, 2020 have provided greater direction for Medicare Advantage and Part D plans allowing for greater flexibility for these plans to offer and discount telehealth for specialty care. However, this doesn’t address all types of visits or reimbursement rates and does not provide direction for all government-provided healthplans.4 For providers and payers to invest in the necessary infrastructure, clarity around reimbursement, compliance, data security requirements, and patient outcome metrics will be essential.
Virtual care, including telehealth services and remote patient monitoring, allows providers and payers to reach and engage more patients and to minimize delays in care. These virtual platforms, supported by the use of data and analytics to understand the needs at the community and individual levels, are especially impactful in addressing the long-existing health disparities in our country, according to some organizations who are focusing efforts in those specific areas.5
The pandemic required payers to develop new strategies and processes to address these virtual needs both from a business and patient care perspective. These strategies will not only help shape the future of how healthcare is delivered but have already brought about the genesis of new types of organizations.3 These new payer and provider organizations are founded with the intent to deliver enhanced, technology-supported care that is not beholden to our traditional fee-for-service payment models or existing infrastructure. These organizations have started with a new vision and a clean slate to reimagine how healthcare is delivered and consumed.6 Many will welcome these next-generation payers and providers as they help us move closer to a value-based healthcare system.
- Siwicki B. Comparing 11 top telehealth platforms: company execs tout quality, safety, EHR, integrations. August 2, 2017. Accessed June 30, 2020.
- Mehrotra A, Linetsky D, Hatch H. This is supposed to be telemedicine’s time to shine. Why are doctors abandoning it? June 25, 2020. Accessed June 29, 2020.
- Waddil K. Beyond COVID-19: telehealth, partnerships, member engagement. June 5, 2020. Accessed June 30, 2020.
- Minemyer P. CMS finalizes plan to allow Medicare Advantages plans to expand telehealth benefits. May 22, 2020. Accessed June 29, 2020.
- Minemyer P. How Cambia Health Solutions is tackling critical health disparities amid COVID-19. June 2, 2020. Accessed June 30, 2020.
- Stotz C, Zweig M. Next-generation payers and providers: setting a strategy for tech-enabled innovation. Accessed June 30, 2020.