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 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.