With the onset of the COVID pandemic, regulatory changes and increased demand have pushed payors to cover telemedicine more widely and develop innovative approaches to collaborate with providers. These instances of payor-provider collaboration are increasing health plan member access to care while keeping them engaged with their health. 

CareFirst Equips Independent Physicians with Telehealth Platform

CareFirst Blue Cross Blue Shield (CareFirst) in Maryland is offering independent physicians complimentary access to a telehealth platform, DrFirst’s Backline Telehealth, with the goal of increasing member access. CareFirst’s partnership with the Maryland State Medical Society (MedChi), will equip eligible MedChi physicians with the technology they need to provide virtual care during the COVID-19 pandemic and beyond.

BCBSMA Amps Up Telemental Health Offerings; Guarantees Continued Payment Parity for Telehealth

To address surging mental health needs during the pandemic, Blue Cross Blue Shield of Massachusetts (BCBSMA) recently announced that it would offer telemental health visits through its online platform. It will also expand member access to an mHealth platform offering aid for mild to moderate mental health issues, and reimburse telehealth visits on par with in-person ones, even after the COVID-10 crisis subsides.

Since expanding coverage in mid-March, BCBSMA has already processed 2.5 million new telehealth claims. They are also increasing reimbursement rates for child psychologists by 50% to handle surging demand.

“Taken together, we believe these initiatives will help address a critical need at a time when access to high quality mental health services has never been more important,” Andrew Dreyfus, the health plan’s president and CEO, said in a press release.

UnitedHealth Group Launches Remote Monitoring Program to Better Manage Chronic Disease

With diabetes rates increasing across the country and diabetes management costing the healthcare industry over $300B in 2017, UnitedHealth undertook a proactive approach that included remote monitoring to better manage this chronic condition. 

The payor used a continuous glucose monitor to gather member data, incorporated activity trackers and app-based alerts, and compiled members’ health data in an individual health record, which included social determinants of health data, pharmacy claims, and medical records. UnitedHealth initiated proactive outreach with members whose data trended negatively. It also reduced administrative burden for providers by eliminating the requirement that they obtain prior authorization for the continuous glucose monitor used in the program. 

Participants have already seen positive results in their weight and chronic disease, with some members achieving remission from type 2 diabetes.

What’s Next: The Democratization of Data 

How can payor-provider collaboration improve moving forward? Many experts point to the democratization of data as the next step in creating solid payor and provider partnerships. Sharing a single source of truth helps payors and providers stay on the same page, collaborate more effectively, and analyze outcomes more accurately.  

In recent interviews with DocASAP CEO Puneet Maheshwari, Dr. Benjamin Edelshain, Vice President of Clinical Engagement and Digital Innovation at a leading health insurance organization, discussed the democratization of data and the breaking down of barriers among payors and providers due to COVID-19. He emphasized the importance of creating a comprehensive view of the patient that integrates payor and provider data.

“Underlying [payor-provider collaboration], I think it’s important that we ensure an overarching data infrastructure that’s consistent and one source of truth between payor and provider. That requires investments in technology platforms that enable that holistic view of the member grounded in the latest clinical expertise, and also makes sure we’re driving proven outcomes,” Dr. Edelshain explained. 

The COVID-19 pandemic has accelerated data sharing and helped both payors and providers move away from the mentality that data hoarding somehow offers their organizations a competitive advantage.

“What [COVID-19] has taught us is the value of liberating data to drive better outcomes,” Dr. Edelshain noted.  “It’ll be interesting to look at retrospective studies and see what pockets of the country were willing to share, how did that change outcomes, and what can we attribute to that?” 

Next steps

To learn about shifting consumer preference for care, patient satisfaction with telemedicine, and the most in-demand digital tools, view our eBook, Telehealth: Taking the Healthcare Consumer’s Pulse in the New Normal.

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