Category: Telehealth

Don’t let chronic conditions be an afterthought when using telehealth

If there’s one silver lining to COVID-19, it’s the rapid adoption of telehealth that enables physicians to take care of patients while also limiting the spread of the virus. The Centers for Medicare & Medicaid Services (CMS) even expanded its list of telehealth-covered services during the public health emergency, allowing physicians to render certain preventive care, evaluation and management of conditions, and other services without requiring patients to come into the office.

One unintended consequence?

When using telehealth, physicians may be less likely to capture chronic conditions that affect risk-adjusted payments. Why? Lack of time, new workflows, and a variety of other causes.

This is detrimental to risk adjustment for two reasons. First, it can affect the quality of patient care—particularly during care transition when documentation becomes critical. Patients who benefit the most from remote care during the pandemic are often those that tend to have multiple chronic conditions. However, it is still critically important to capture patient complexity through appropriate documentation and coding.

Second, it negatively affects physician reimbursement under capitated or risk-based payment models. When documentation and medical codes don’t paint an accurate picture of patient severity, physicians receive fewer resources for those patients who are inappropriately perceived to be less clinically complex. The same is true for government-sponsored payers.

The good news is that a comprehensive risk adjustment and quality solution can help by taking some of the administrative burden off physicians so they can concentrate on providing high-quality patient care. The first step, though, is to address common myths about telehealth in a value-based care environment.

Below, we address three myths about telehealth as well as strategies to help physicians depict a more accurate picture of patient severity, acuity, or complexity when using this technology.

Myth: ‘I only have time to focus on the acute problem during a telehealth visit. I can’t possibly capture chronic conditions as well.’

Truth: Although physicians are often pressed for time during an encounter, it only takes a few seconds to check in with the patient about the status of their chronic conditions. It can be as simple as asking the patient whether they are taking their medications as prescribed for each chronic condition.

Physicians can also participate in health-plan sponsored risk adjustment and quality of care initiatives that can help them report the quality of care they normally provide. These initiatives provide clinical and administrative support to ensure accurate and comprehensive documentation and coding so physicians can spend more time on direct patient care.

Myth: ‘It’s too difficult to provide an Annual Wellness Visit (AWV) via telehealth. Care quality will suffer.’

Truth: In a recent survey, 49% of physicians cite ‘diminished quality of care’ as a top reason why they haven’t provided a virtual consultation. However, decreased care quality with telehealth isn’t yet proven, and for some patients, it may be the only way to get them in the door—albeit a virtual one. The AWV is an opportune time to capture and manage chronic conditions. During COVID-19, this is more important than ever as these diagnoses may place patients at higher risk for developing complications if they were to contract the virus.

Deferred care during COVID-19 has become all too common. Four in 10 U.S. adults reported avoiding medical care because of concerns related to COVID-19. One recent survey found that patients with chronic conditions are less engaged and that fewer patients are seeking preventive care. This means chronic conditions could go undetected and unmanaged for months at a time. There may also be missed opportunities for routine vaccinations or early detection of new conditions, both of which could result in poor patient outcomes.

Health-plan sponsored risk adjustment and quality of care initiatives help physicians efficiently provide critical preventive care services without jeopardizing the time spent on patient care.

Myth: ‘Telehealth won’t help me succeed under value-based payment models. It’s too risky to embrace this new technology knowing that my revenue could suffer.’

Truth: Telehealth is in no way a barrier to value-based care. In fact, it enhances value by increasing patient access and providing physicians the platform to capture and address chronic conditions.

In fact, more than 75% of clinicians responding to a recent survey said telehealth enabled them to provide quality care for an array of conditions and situations: COVID-19, acute care, chronic disease management, hospital follow-up, care coordination, preventative care, and mental/behavioral health. Additionally 60% reported that telehealth has improved the health of their patients, and the majority would like to continue to offer telehealth visits following the pandemic.

With the help of health-plan sponsored clinical and administrative support, physicians can use telehealth to improve quality care reporting while also supporting revenue integrity through accurate and complete data capture.

How Vatica Supports Providers

Physicians providing care via telehealth need extra support. Our team deploys on-site or virtual clinical consultants with backgrounds as RNs, LPNs, or PAs that serve as extensions of your team at no cost to the practice to help surface important items to address with paitents in a virtual or in-office setting, such as chronic condition management. Practices retain all fee-for-service payments generated from patient encounters and also receive incentives for coding visits.

The best part? It’s a health-plan sponsored initiative. That means it’s completely free for practices to participate. Learn more about how Vatica can help your practice.

Telling the patient’s story during COVID-19: Primary care challenges and long-term solutions

When the COVID-19 pandemic first struck, small independent primary care physicians were among the first providers to feel the impact. Patients cancelled appointments out of fear or necessity. Practices shut down temporarily to comply with shelter-at-home orders. As with many businesses, some practices eventually closed their doors for good because they simply couldn’t weather the storm financially. As the pandemic raged on, even larger, system-owned practices began to feel the wrath of COVID-19. Today—nearly a year later—entire health systems both large and small are feeling the strain.

Despite these unprecedented challenges, providers have tried not to lose sight of the most important goal: to provide high-quality patient care that drives optimal health outcomes and supports the transition to value-based care.

How can they do that?

Ensure accurate and complete documentation that reflects each patient’s clinical story. Document all current and emerging chronic conditions to the highest degree of specificity. Administer all age-based or seasonal screenings and vaccines that affect health and functioning, or refer patients for these services. Encourage preventive care and behavior modification to support a healthy lifestyle.

As we look ahead, organizations must confront an ongoing shortage of primary care physicians and nurses, as well as a virus-fearful patient population that may be difficult to engage in preventive health. The ‘old way’ of addressing gaps in patient care (like during an in-person visit with a physician) probably isn’t realistic anymore. It’s time to rethink strategies and address ongoing challenges.

Following are four challenges every healthcare organization must address, along with potential solutions to ensure high-quality patient care and revenue integrity.

Challenge #1: There aren’t enough physicians working in the practice setting.

An increase in hospital admissions—including admissions for patients with COVID-19—has forced health systems in rural and urban areas to re-deploy employed physicians and their nursing staff into acute care units. With fewer providers working in the office setting comes diminished appointment availability, including appointments for preventive health. This comprehensive annual visit is a critical opportunity to identify conditions that warrant ongoing monitoring. Without this touchpoint, care gaps can easily occur. The patient’s clinical story remains largely untold, and performance in value-based care arrangements may be jeopardized.

Solution: Think outside the box.

It’s understandable that physicians are distracted by other responsibilities; however, it’s also critical that they not lose sight of reviewing patients’ chronic conditions annually. That’s where they may need help. Some have contemplated hiring a physician assistant, for example, but are hesitant to make the financial investment out of fear that patient volume won’t cover the person’s salary and benefits. The good news is that there may be other options. For example, the practice could consider participating in a health-plan sponsored program that provides clinical and administrative staff for support. Going this route prevents care gaps, reduces overhead costs, and slows the spread of COVID-19. As an added benefit, there is often a financial incentive offered for completing patient encounters.

Challenge #2: Some patients still fear coming into the office.

Even despite stringent COVID-19 protocols, many patients continue to feel that the risk of coming into the office for preventive and routine care isn’t worth it. Four out of every 10 U.S. adults say they’ve avoided medical care because of concerns related to COVID-19.

Solution: Telehealth (with patient tutorials).

Telehealth helps practices keep patients happy and safe. However, there’s one caveat: it might take a little effort to help older adults learn to use this technology. More than a third of adults over age 65 face potential difficulties seeing their doctor via telemedicine. Proactively educating patients on how to use the telehealth solution and supporting their utilization can go a long way in terms of engagement. Administrative support often includes the use of Patient Engagement Representatives to contact patients to schedule appointments, deliver appointment reminders, and educate them on telehealth tools.

Challenge #3: Patients may no longer prioritize preventive health.

During COVID-19, many patients have deferred routine and preventive care. Perhaps they lost their insurance or faced another type of financial hardship—or the physician they always saw is no longer available. Some may have even gravitated toward the idea that they don’t need a doctor because they’re able to self-diagnose using the internet. Routine and preventive health falls to the bottom of the priority list, which is especially critical for patients diagnosed with chronic conditions.

Solution: Educate patients.

Practices must be able to convey the value of preventive and routine health services. Preventive care helps physicians diagnose diseases earlier, which often results in better outcomes and lower cost of care. Routine care prevents exacerbations, reduces symptoms, and improves quality of life. Practices must be able to engage patients on a personal level while also explaining that many of these services may be covered at 100%. This education empowers patients to make the best decisions for their health.

Challenge #4: Physicians are burned out, and revenue is declining.

Forty-seven percent of family medicine physicians and 46% of internal medicine physicians say they’re burned out, and it isn’t surprising why: long and busy workdays, time pressures, and ever-increasing administrative demands. COVID-19 has exacerbated this dynamic and led to a sharp decline in patient volume that has threatened the financial viability of many PCP practices.

Solution: A comprehensive Risk Adjustment and Quality solution.

Participating in health-plan sponsored risk adjustment and quality of care initiatives can help PCPs who are struggling to close revenue and care gaps. PCPs are already overworked and dealing with the cascading effects of COVID-19. It’s critical to find a partner that provides dedicated clinical and administrative support services to reduce administrative burdens, engage patients, and improve health outcomes. The result? Increased utilization of preventive health encounters and improved financial and clinical performance in value-based care arrangements.

How Vatica Supports Health Systems

As practices continue to seek point-of-care solutions to better tell each patient’s story, they need look no further than Vatica Health. We’re accelerating the transformation to value-based care by helping providers, health plans, and patients work together to achieve better outcomes. Our team deploys on-site or virtual clinical consultants with backgrounds as RNs, LPNs, or PAs that serve as extensions of your team at no cost to the practice. Practices retain all fee-for-service payments generated from patient encounters and also receive incentives for coding visits.

The best part? It’s a health-plan sponsored initiative. That means it’s completely free for practices to participate. Learn more about how Vatica can help your practice.

Telehealth-enabled risk adjustment: A solution to closing revenue and care gaps

Providers have exerted a herculean effort over the last few months to minimize the human cost of the COVID-19 pandemic. Yet, the unfortunate irony of these efforts, to keep patients and communities safe, is the negative impact on the group considered to be the linchpin of the healthcare ecosystem: primary care physicians (PCPs).

A recent Harvard study estimates visit cancellations due to the COVID-19 pandemic will cost practices, in 2020, an average of $67,000 in annual revenue per physician. Across the entire primary care system, the loss adds up to nearly $15 billion. Notably, the study estimates that the impact could more than double if COVID-19 telemedicine policies are not sustained.

PCPs and the primary care ecosystem can’t afford such a massive blow, which would threaten the viability of thousands of providers. When we emerge from the acute phase of the pandemic, it will be more essential than ever to have a robust primary care system to meet the pent up healthcare needs—especially among the aging population with multiple chronic conditions.

The study’s lead author, Dr. Bruce Landon, told the Boston Globe, “If we fail to pay attention to [PCPs], many of them are at risk for going away.” Paying attention, in this case, means continued legislative support for telehealth and care delivery flexibility. It also means giving providers the tools and solutions to maintain their quality of care and create new sources of revenue. It is particularly important for PCPs to keep their senior patients—the population at greatest risk for falling through the telemedicine cracks—engaged in ongoing routine and preventive care.

Starting in March, CMS took unprecedented action to expand telehealth services and benefits. Among the key changes has been CMS approval of audio and video telehealth as a means to gather diagnostic data for purposes of risk adjustment—a move that has been critical for Medicare Advantage (MA) plans to keep up with risk adjustment and quality of care initiatives.

For PCPs struggling to close revenue and care gaps, performing health-plan sponsored risk adjustment via telehealth represents a great opportunity. “The temporary expansion of telehealth is a tremendous opportunity—if it’s utilized,” said our CEO Hassan Rifaat, MD in an article authored for Fierce Healthcare. “Because telehealth is new for most providers and for much of the Medicare population…it is important to implement easy-to-use technology and efficient workflows,” he explained. “In these extraordinarily challenging times, it’s important to be creative and proactive to keep patients healthy and the system financially afloat.”

Participating in value-based arrangements, addressing gaps in care, and achieving strong clinical outcomes during this time is especially arduous for PCPs who are burdened with the operational, technical, resource, and practical challenges resulting from COVID-19. Vatica Health has developed a PCP-centric, workflow-agnostic solution that provides free clinical and administrative support, remote EMR access and connectivity, audio and video interface, member engagement, and other services to help providers thrive clinically and financially during these challenging times. Contact Vatica Health at to learn how we can support your practice.

Learn more about Vatica Health’s PCP-centric solution for risk adjustment to improve practice performance and patient experience.

Optimizing real-time audio-video telehealth to boost your PCP practice in the pandemic

We’ve said it before: primary care providers are facing the perfect storm sparked by COVID-19. There are fewer routine and preventive visits, revenue is down, and offices are short-staffed. Fortunately, there is a path forward.

Telehealth has skyrocketed and is becoming the most practical way of providing primary care during these uncertain times. However, despite the surge in telehealth popularity, PCPs are having trouble taking full advantage of the benefits that telehealth offers to boost their practices – especially among seniors.

In a recent on-demand webinar, Dr. Hassan Rifaat (Vatica Health’s CEO) and Daphney Vick (Vatica Health’s EVP, Operations) were joined by two primary care physicians that use Vatica Health’s solution. They shared their insights on how providers can leverage telehealth (especially real-time audio+video) to generate revenue, help patients stay on track with routine and preventive care, and keep their practices productive and financially viable. Below are a few highlights from the webinar.

Telehealth is here to stay

Providers have been quick to adapt to telehealth and, thanks to recent rulings, many PCPs plan to keep telehealth as an option post-pandemic after seeing the value that it can provide for routine care and reimbursable visits. Many health plans are also moving toward the permanent expansion of telehealth services.

But there is an important distinction between providing care using audio only – and more comprehensive telehealth as defined by CMS which requires real-time audio and video. While telephone-only may be satisfactory in certain circumstances, the key to maximizing telehealth is to ensure that it can also be used for risk adjustment, value-based care and other performance optimizing programs. For HCC coding in support of risk adjustment, CMS guidance states that PCPs’ telehealth options must be real-time audio-visual, and not just telephonic.

Real-time audio+video telehealth is not just better for the practice, it’s also better for patients. Imagine watching a movie versus just listening to it—there’s much more information to absorb, and it’s also more engaging. Patients agree: 62% of patients at MGH reported in a survey that the quality of care via video visits was the same as in-person visits.

Patients are already set up for success

While patient adoption of telehealth has been a hurdle for PCPs, some data shows that it’s catching on. Fifty-two percent of senior patients are willing to try telehealth, and many of them already have. Additionally, when asked about switching PCPs based on telehealth offerings, or lack thereof, the vast majority of seniors would rather stay with their own PCP. This is good news because there is a proliferation of telehealth service providers that are aggressively targeting your patients, making telehealth an important initiative to retain your patients.

In our webinar, family physician, Monica Ranaletta, DO, shared that the learning curve for video telehealth has been quick and easy. Once her patients have one video telehealth visit, even with another provider, the process becomes intuitive.

Also, on the webinar, Shanthi Rajendran, MD, and her colleague Sarah Boyer, PA, shared that they have been surprised at how equipped their senior patients have been for telehealth. Keeping up with the times and with their younger family members, many seniors already had the basic video tools in place to do audio-visual telehealth.

Taking the next steps with audio-video telehealth

Though patient adoption of telehealth is growing, it doesn’t just happen overnight and can take some time for providers to get the ball rolling and the process optimized.

On the webinar, the Vatica Health team, joined by Dr. Rajendran, Boyer, and Dr. Ranaletta, shared some key steps that providers can take to improve the use of telehealth for their patients and their practices, including:

  • Member engagement to drive participation and utilization
  • Educating patients about your practice’s telehealth options and use cases
  • Administrative functions to make telehealth an easy option for patients
  • Pre-visit tasks that help ensure patients are ready for appointments and show up for them
  • User experience and platform tips that help make telehealth clear and enjoyable
  • In-visit best practices for keeping patients engaged and improving their overall experience

Boyer shared that though this may seem like a lot to think about, she and Dr. Rajendran have found a rhythm and have successfully integrated telehealth into their operations. The experience is similar for Dr. Ranaletta, who estimates that 80% of her appointments are now via telehealth.

To hear more from our team and Vatica Health’s PCPs using telehealth to improve their practice performance and patient experience, watch the on-demand webinar.

COVID-19 primary care challenges and opportunities

The coronavirus has created a unique and challenging dichotomy in healthcare—some physicians in acute care settings are overwhelmed with urgent patient needs and other providers in outpatient settings are experiencing a massive decrease in volume.

Understandably, much of the public attention is on the busiest parts of healthcare, and to those frontline caregivers at hospitals, urgent care centers, and nursing homes, we simply say, thank you.

On the other hand, primary care providers are at a standstill. For PCP practices, particularly those who serve seniors, the virus presents some daunting challenges: preventive and routine care is simply not taking place, volume and revenue have plummeted, and offices are short-staffed. These factors are creating a perfect storm that is literally jeopardizing the survival of PCP practices and putting the lives of patients suffering from chronic diseases at greater risk.

Fortunately, there is a path forward. Unlike much of the doom and gloom circulating the web, we won’t just focus on the magnitude of the problems – we’ll provide a creative solution.

Declining Patient Volume

Across the country, in-person clinical visits—the foundation of primary and preventive care—have decreased at an alarming rate. In a mid-April survey, PCPs reported that their volumes had plummeted by 65%, with seniors showing the sharpest drop in visits. Office closures and decreased volume are threatening the financial viability of PCPs, especially smaller and independent practices.

Declining Practice Revenue

With the rapid decrease in patient volume, practices are now facing a severe financial strain as their revenue follows a similar trajectory. While telehealth has helped PCPs replace some in-person visits, these interactions have not led to significant, reimbursable revenue yet. Though 96% of primary care visits authorized for Medicare beneficiaries are now eligible for telehealth reimbursement, inconsistent guidelines and poor member engagement have made it challenging for providers to take full advantage of telehealth. All of this is creating a stark new reality – only one third of PCPs feel confident that their practice has enough cash to continue operating for the next month.

Declining Member Engagement

The disparity between reimbursable telehealth visits and the PCPs’ ability to take advantage of them boils down to engagement. Telehealth appointments, unfortunately, are not being adopted at the same rate that in-person is being abandoned. Additionally, many of the Medicare telehealth waivers require real-time audio and video communication, and providers are finding it difficult to identify easy-to-use platforms for seniors that also integrate into their practices’ workflows.

Practices are Short-Staffed

During this time, PCPs are facing unprecedented business and staffing decisions. Four out of 10 PCPs recently reported having to reduce their staff headcount. Many others are on rotations to keep staff healthy or are accommodating whatever situations employees may be facing in their own families. This has led to a precarious situation. The PCPs, who were already overworked pre-pandemic, are now left to do the back-office work—scheduling, follow-up, billing, technology, and more—on top of visiting with the patients they can get through the virtual doors.

Increasing Risk for Seniors

Given seniors’ increased risk of developing more serious complications from COVID-19 illness, it is especially important to keep them physically isolated. The Catch-22 is that as the months tick by without proactively managing existing chronic conditions, their long-term risks of serious illness rise significantly. Furthermore, social isolation has been linked to decreased cognitive function, depression, cardiovascular disease, and many other health risks.

The Solution: A Risk Adjustment and Quality of Care Solution at the Point of Care

For many years, PCPs were led to believe that HCC coding in support of risk adjustment was best left to home assessment or other vendors not connected to the treating provider. Despite the many shortcomings of this approach—patient abrasion, no access to EMR or medical records, lack of follow-up care—PCPs reluctantly accepted these inferior methods because they lacked the tools, resources, and time to do this work themselves.

All that changed when Vatica Health pioneered a PCP-centric risk adjustment and quality of care solution supported by expert clinical teams with cutting-edge technology at the point of care. Vatica Health empowered PCPs to “take back” risk adjustment assessments, helping thousands of PCPs dramatically improve care and their financial performance. Then COVID-19 happened.

While CMS significantly expanded telehealth benefits in early March, it did not address the face-to-face requirement for risk adjustment. Fortunately, on April 10, the healthcare ecosystem exhaled a collective sigh of relief when CMS officially approved telehealth as a means of gathering risk adjustment data. And while that’s good news for providers and health plans, rolling out telehealth isn’t as simple as flipping a switch.

With all the challenges PCPs are facing, the last thing they need is another burden. PCPs need turnkey solutions to keep their practices running and their patients healthy. Vatica Health is here to help. We are proud to support your practice by offering clinical and administrative support to get patients back through your virtual doors, and to efficiently perform health plan sponsored risk adjustment and quality of care documentation, via telehealth.

We are a PCP-centric partner, and we are here to help you get through these challenging times.

The impact of telehealth on risk adjustment

In our recently published whitepaper, and in an article by our CEO, Hassan Rifaat, MD, published in FierceHealthcare, we discussed the current challenges health plans face to meet the requirements for risk adjustment during the COVID-19 pandemic. In the early innings of the coronavirus crisis, CMS implemented many helpful initiatives in response to the national emergency declaration, but none addressed risk adjustment. This created a lot of anxiety among health plans and other at-risk entities, given the importance of accurately risk adjusting your membership. Our hope, at the time, was that CMS would build on its series of telehealth waivers from March to allow health plans to gather risk adjustment data through telehealth visits.

Well, our dream has become a reality. Late last Friday, April 10, we all exhaled a collective sigh of relief when CMS officially approved telehealth as a means for health plans to gather risk adjustment data.

We applaud CMS for making this move, as it allows Medicare Advantage plans—which insure many of the oldest and sickest patients—to stay on track with risk adjustment. In addition, to the extent that the risk adjustment solution is provider-centric, it also enables primary care physicians (PCPs) to uphold care quality and address care gaps through preventive and routine care.

And while that’s good news for health plans, rolling out telehealth isn’t as simple as flipping a switch. PCPs and seniors may face obstacles in adopting and integrating what is a new technology for many of them.

During this period of transition, health plans should recognize the new challenges PCPs face and support them in continuing to provide care to their patients.

Challenge: Disjointed Telehealth Strategies

Telehealth usage is increasing but may be disjointed between audio and video methods and external telehealth solutions. In order to capitalize on the telehealth risk adjustment waiver, visits via telephone alone will not be enough. CMS has stated that PCPs can only gather encounter data for risk adjustment via real-time, interactive audio-video telecommunication systems.

Additionally, many outsourced telehealth solutions use clinicians with no relationship to patients or connectivity to a PCP’s EMR. While such solutions may be effective to treat acute needs when a patient’s PCP is unavailable, they should not be a substitute for a PCP-centric telehealth solution for risk adjustment and care coordination. Outsourced telehealth solutions will likely be ineffective and cause significant provider abrasion at a time when PCPs are struggling to keep their practices open.

Solution: Centralized, PCP-Centric Approaches

During this time, PCPs need solutions that keep them productive and engaged with their patients, rather than creating more work by picking up the pieces of an outsourced telehealth solution. PCPs also need support implementing this new care delivery model into their workflow.

Challenge: Strained and Under-staffed PCPs

As coronavirus care impacts all aspects of our business and personal lives, PCPs are under considerable stress, and their financial viability is being threatened. A survey of physicians in mid-April revealed that patient volumes are down 65% compared to pre-pandemic volumes, and the effects are beginning to catch up to the PCP practices. Shockingly, due to coronavirus effects, only one-third of PCPs feel confident that their practice has enough cash to continue operating through the end of April. Some practices have already decreased their workforce, and others think they’ll have to temporarily shutter their doors.

Solution: Member Engagement

Even though telehealth is now an option, practices still need help getting patients to participate. PCPs need easy-to-use member engagement tools with administrative and clinical support to secure patient participation. To optimize participation, health plans should promote PCP-centric telehealth to the members. Not only can this help maintain risk adjustment programs, but it also helps PCPs generate reimbursable revenue at a time when it’s needed most.

What’s Next?

While it’s hard to imagine that telehealth will ever fully replace in-person care, we expect that it will be our “new normal” for quite some time. This is especially true for seniors who are at the greatest risk of complications from COVID-19. We are cautiously optimistic that telehealth will remain in place for routine and preventive care and, if it does, we would expect CMS’ new guidance on risk adjustment via telehealth to also be extended. In the meantime, health plans should lean into PCP-centric telehealth programs to take full advantage of the new rules and flexibility relating to telehealth and risk adjustment during COVID-19.

Learn more about Vatica Health’s new PCP-centric telehealth and risk adjustment solution.