Tag: telehealth

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

By Vatica Health | July 23, 2020 | Provider, Telehealth

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 info@vaticahealth.com 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.

The impact of telehealth on risk adjustment

By Vatica Health | April 22, 2020 | Risk Adjustment, Telehealth

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.

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