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3 Ways Telehealth Improves Health Plan Performance

by Paige Kilian, M.D., VP and Chief Medical Officer, on May 8, 2020
Paige Kilian, M.D., VP and Chief Medical Officer

Telehealth is the topic on the minds of so many in healthcare today. Also referred to as virtual health, telehealth seems to be having its moment in the sun. Although the concept of telehealth services has been around for decades, and telehealth services have been offered in many settings for several years now, telehealth is just now entering the healthcare industry stage as a key player, largely driven by its ability to support the industry’s response to the recent COVID-19 crisis.

In the wake of this public health emergency, physicians and many other healthcare providers are accelerating the adoption of workflows for virtual care or at least exploring the idea of expanding access to care by offering on-demand care for members. This is especially true as the Centers for Medicare and Medicaid Services recently released guidance stating that diagnoses from telehealth visits fitting specified criteria, can be submitted for risk adjustment payment purposes.  While the COVID-19 pandemic may have created an immediate need for a virtual health option to allow for social distancing, helping to avoid the spread of the virus, it is important that health plans recognize it as a valuable long-term component of an integrated healthcare delivery model for payers, providers, and member alike. This is a strategy that drives efficiency, enables health plans to realize increased member satisfaction and engagement, and improves economic performance by way of risk score accuracy improvement.

Driving Program Efficiency

At times, Medicare Advantage and Commercial ACA members’ health conditions go untreated or undiagnosed simply because members have limited access to care, such as a lack of reliable transportation.   As a result, appropriate treatment and documentation may suffer. Reducing these barriers so that members can be seen by a physician remotely at a time that’s convenient for them without leaving their home helps ensure quality and risk documentation gaps that otherwise may remain unclosed, are addressed, enabling appropriate reimbursement, greater operational efficiency and increased risk score accuracy.  On-demand health visits can also support supplemental member encounter completions for Managed Medicaid, Medicare Advantage and Commercial ACA members, which will increase quality measure outcomes and improve the health of your member population and overall plan performance.

Improving Member Engagement and Retention

telehealth/virtual care

Who doesn’t like options and the freedom to choose the services that best suit their needs and personal preferences? In a world where convenience is key, liking and trusting your doctor is no longer enough to keep members coming back. Modern technology has made it possible to purchase products and services with the click of a button, without ever leaving home. Why should it be any different for healthcare? In many cases, it doesn’t have to be. Apart from more critical and complicated care needs and those encounters that require a physical exam, telehealth services meet an important need for today’s healthcare consumer.

It’s hardly surprising that people favor access to services that are convenient. Organizations delivering healthcare that caters to the member as opposed to the convenience of the health system will experience more success with retention and engagement. Most times, in-office visits include travel, possible wait times and interaction with office staff. Despite the quality of care a physician provides, these things can be seen an inconvenience and often leave members dissatisfied. Enabling members to address their healthcare needs through the modality that best serves them at a given point in time will translate to increased retention rates. When members are effectively stratified, proactively engaged and subsequently empowered to choose their ideal care setting, they are more likely to stay with their health plan.  According to a survey from the Black Book Market Research, 90% of members no longer feel obligated to stay with a provider who can’t offer a satisfactory digital experience. The goal is delivery of excellent healthcare; improving member access, engagement, and experience through a virtual health option allows health plans to meet this objective.

Increasing Economic Impact

While there are many benefits to providing telehealth services, one of the more popular among them is its economic impact. A report produced by the American Hospital Association states that programs using virtual care saved 11% in costs and more than tripled their ROI. Specifically, the use of remote monitoring services and remote analysis are significantly reducing healthcare costs, providing savings for health plans, members and providers. On-demand care is also proving to eliminate non-urgent emergency room visits and trips to the doctor’s office, enabling members to avoid unnecessary transportation expenses. Members are seeking accessible, convenient, safe services − and organizations using telehealth could see a reduction in cancelled appointments and potentially begin to attract new members, thereby also driving new revenue. Health plans can realize billions of dollars in efficiencies through the use of web-based care, as these virtual visits allow for the accurate documentation of diagnosis codes affiliated with a Hierarchical Condition Category (HCC) for CMS risk adjustment filings. This ensures accuracy of payments received from CMS.

It’s About That Time

telehealth services

According to a report by “Global Telemedicine Market Outlook 2022,” as of 2017, telehealth was a $29.6 billion industry, and is expected to grow by another 19% by 2022. If you haven’t yet noticed, telehealth is quickly becoming a pillar of healthcare delivery, and continues to pick up steam before our eyes. It’s time to expand care options and reduce barriers for your members through innovative initiatives that also enable you to remain competitive in the market and attractive to new members.

Adopting telehealth services within your program will lower healthcare costs, improve the efficiency of your program, drive revenue, and increase access to healthcare services for your members – all of which reinforces your commitment to their healthcare and satisfaction. This will produce a much happier and healthier member population that is more likely to remain with your health plan.

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