Moving From Blockbuster to Netflix: Telemedicine as a Path Forward in Value-Based Care

At the onset of the COVID-19 pandemic, value-based care appeared to be in trouble as accountable care organizations (ACOs) pulled out of risk-based programs. Meanwhile, telemedicine has surged to compensate for the decline in in-person appointments across the country. Now, another side of the story is emerging where telemedicine can better enable value-based care — and vice versa. How do these care delivery models work together? What impact may they have on patient access and outcomes?

The COVID-19 crisis resulted in an unprecedented uptake in telemedicine, with the Centers for Medicare & Medicaid Services (CMS) reporting exponential growth from 13,000 telehealth visits the week before COVID hit to more than 1.7M visits among Medicare beneficiaries the last week of April. Patients and providers alike feel confident that telemedicine is here to stay, and CMS has expressed its commitment to continuing to support telehealth innovation, with the possibility of permanently loosening some its regulations and continuing to pay for telemedicine as we move out of the crisis. 

As Hospitals Face Huge Losses, Short-Term Participation in Value-Based Care Decreased

Meanwhile, hospitals and health systems across the US are facing huge losses in revenue, as they have quickly stepped up to meet the challenges of treating COVID-19 patients and delayed and deferred profitable elective surgeries and procedures. The American Hospital Association estimates that the total four-month financial impact of the COVID-19 crisis on America’s hospitals will be more than $200 billion.

Given these financial challenges, it is not surprising to see a short-term decrease in healthcare providers’ participation in value-based care models, which reimburse them based on quality (or value) metrics as opposed to the quantity (or volume) of services delivered, and often involve providers taking on risk. In fact, a survey of 226 ACOs indicated that more than half of them said they were likely to quit their value-based contracting because of fear of having to pay massive losses resulting from the COVID-19 pandemic.

However, in the long-term, we believe that the pandemic has exposed the desperate need for value-based care, and the huge growth in telemedicine will play a transformative role in enabling it.

Patients with poorly managed chronic conditions such as diabetes, obesity, and cardiovascular disease have been hit hardest by COVID-19. Better managing these populations requires a comprehensive approach to care that integrates telehealth, remote patient monitoring, and digital health education, while focusing on the Institute for Healthcare Improvement Triple Aim: improved outcomes, better patient experience, and lowered costs for care. 

Proactive Telemedicine Can Improve Outcomes and Lower Costs

Traditionally, telemedicine has been used in a reactive model to respond to low-acuity, on-demand patient requests. With a focus on value-based care and patient outcomes, health systems have the opportunity to use telehealth in a proactive way, reaching out to patients facing care transitions, closing gaps in care, and monitoring patient adherence to chronic care management plans. Proactive virtual care could also help reduce preventable readmissions and document screening compliance.

Moving forward, Ashok Rai, MD, President and CEO of Prevea Health, believes that 40%-50% of all visits could take place through telemedicine, with other technologies layered in as needed. For health systems operating under value-based contracts, this could create significant savings as their cost structures decrease. Dr. Rai suggests investing these savings into continuing to grow their telemedicine platforms.

For more of Dr. Rai’s insights on COVID-19’s impact on patient care and the payor-provider relationship, access his full interview in our New Normal Interview Series.

The Future of Medicine: Abandoning Blockbuster for the Convenience of Netflix?

The huge influx in telehealth services during the COVID-19 crisis has created a sea change in the way telemedicine is viewed by patients and providers alike. 

Jay Parkinson, MD, MPH, CEO and Co-Founder of Sherpaa, and Chief Designer at Crossover Health, posited in a McDermott Will & Emery webinar that in-person care should no longer be viewed as a default, but as the adjunct to online care. He believes that healthcare providers should fully embrace telemedicine as a first response whenever possible, making the transition from the antiquated bricks-and-mortar way of operating (the Blockbuster experience) to the convenient, scalable, online conversations that telemedicine can provide (the Netflix revolution). 

And, further, telemedicine should not be a transaction-based model tied to visits, but an ongoing, proactive project management model with care navigators playing key support roles to clinicians. 

Leverage Telemedicine to Improve Chronic Care and Patient Access

Moving from this transaction-based, sick-care mentality to a proactive health-care mentality is key to success in value-based care. This approach also offers a new and significant way to harness the power of telemedicine to improve chronic care management and patient access to care.

Puneet Maheshwari, CEO of DocASAP, described this opportunity in a recent New Normal Interview: “Efficiencies that are gained because of telemedicine are embedded in overall care pathways in ways we have not done before. Not just providing episodic care, but managing continuing care will lead to more efficiencies, more effectiveness, and, most importantly, will open up more capacity.”  

Now is the time to grasp this opportunity and integrate telemedicine into your value-based care offerings, to optimize the care you provide both during this crisis and as we move out of it.

Next Steps in Optimizing Virtual & Value-Based Care

To learn more about the rapid rise of telemedicine during the COVID-19 crisis and how it is changing the nature of patient access and care delivery, download our free eBook: “The Rise of Telemedicine Virtual Care.”

Access the eBook here.