Is This the Value-Based-Care Tipping Point? Experts weigh in

by | Mar 4, 2021 | Blog

The pandemic, doing in months what was projected to take years, has catalyzed a reaction that’s made virtual care part of healthcare’s new normal. For example, telehealth has become ubiquitous, with many physicians seeing their telehealth volume increase by a factor of 50 to 175.[1]

Meanwhile, the rise of virtual care seems to be similarly catalyzing the trend away from a reactive treatment model and toward a larger emphasis on preventative care, partly because what appeared (pre-pandemic) to be enormous barriers are actually coming down. With the virus having forced patients and providers alike to test old boundaries, the opportunity for more rapid tech adoption seems feasible.

Next-Generation Technologies Could Set the Stage

Writing on the opportunities available with this shift, Tom Moon, formerly a doctor and tech venture capitalist and currently director of Strategy and Business Development at Current Health, points to remote patient monitoring (RPM) as a key ingredient in what it will take to go beyond telemedicine and transform health care.  “Telemedicine,” he says, “virtualizes the existing paradigm of patient-physician consultation…[which] has brought convenience and efficiency for millions of patients. But it’s important to note that a physician’s capability is diminished during a telemedicine consultation compared to an in-person consultation. The doctor cannot check a patient’s pulse, examine their chest or perform an EKG. In short, it is difficult for them to assess and manage the majority of chronic disease patients.”

RPM can help here, but “in a fee-for-service world, there has been no profit to be gained in keeping patients out of the hospital,” Moon says. Plus, the data generated has not been high enough quality to build predictive models that would move the needle on population health. He sees technology capable of capturing a broader set of human health data and continuous data sets to develop predictive algorithms as additional keys to delivering sufficient insight.[2]

Downward Pressure on Cost

Another trend: the fast depletion of Medicare and Social Security trust funds, according to The Medical Group Management Association (MGMA). They predict cost containment will prompt policymakers to leverage new technology and data focusing on prevention, further prompting a shift away from treatment.

With 90% of the $3.5 trillion annual expenditure in U.S. healthcare spent on people with chronic and mental health conditions[3], the financial pressure is high.

The MGMA sees hope in that “Data are beginning to show that services like chronic care management not only improve patient outcomes but save money in the long run. Expect to see greater alignment between reimbursement policy and preventative care, including non-traditional services like telemedicine. Primary care specialties will be obvious beneficiaries of this shift toward prevention.”[4]

In the Harvard Business Review, a team of healthcare industry experts echo the MGMA, noting that to “address their revenue challenges, many health systems will accelerate their movement to value-based care.” One key digital health capability supporting this goal, according to these experts, is remote patient monitoring and other technologies that help patients manage their health.[5]

Moon sees the business case for digital health strengthening, with the Centers for Medicare and Medicaid Services publishing “specific CPT codes for remote vital sign monitoring in January 2019 in an effort to incentivize adoption.” In fact, he reports, “in November, CMS announced its Acute Hospital Care At Home program. The waiver allows hospitals to treat acute patients in their own home and to be reimbursed at the same rates as in-hospital treatment…CMS wants to keep patients out of the hospital and believes that remote monitoring is one way to achieve that.”[6]

The Aspiration to Do More for Patients

But Stephanie Tilenius, founder and CEO of Vida Health, reminds us that “the expense of chronic illness isn’t just financial. According to one study, patients with chronic illnesses may spend two hours a day or more managing their disease.” Citing the old familiar model where an individual feels ill, visits the doctor at a brick-and-mortar office, and leaves with pamphlets and prescriptions, she laments that “follow-up is difficult, not because PCPs don’t care, but because they can’t also be dietitians, certified diabetes educators, personal trainers, and therapists.”[7]

“The alternative model,” she says, “is one where an individual who exhibits risk factors or early signs of chronic conditions experiences integrated care from a team of professionals dedicated to this person’s whole health. Their team guides healthy eating behaviors, suggestions for daily exercise, and managing everyday stressors, depression, and anxiety. Weekly — even daily — check-ins are enabled by virtual visits, augmenting the in-person care they receive. Through messages, video, and audio chats, their providers proactively lead this person to a better lifestyle. And through remote monitoring with connected devices like a Fitbit or connected scale, early risk indicators are caught in real-time. Instead of assigning medications and surgeries, the team can prevent disease onset.”[8]

What could be a more inspiring professional life for a healthcare provider? Fortunately, leading patients to healthier lifestyles that prevent disease onset is at last beginning to sound more and more like an attainable goal.


[1] https://hbr.org/2020/12/what-the-pandemic-means-for-health-cares-digital-transformation

[2] https://www.forbes.com/sites/forbesbusinessdevelopmentcouncil/2021/01/08/what-it-will-take-to-go-beyond-telemedicine-and-transform-health-care/?sh=6f665efb185e

[3] https://www.cdc.gov/chronicdisease/about/costs/index.htm

[4] https://www.healthleadersmedia.com/clinical-care/mgma-highlights-6-medical-practice-trends-new-decade

[5] https://hbr.org/2020/12/what-the-pandemic-means-for-health-cares-digital-transformation

[6] https://www.forbes.com/sites/forbesbusinessdevelopmentcouncil/2021/01/08/what-it-will-take-to-go-beyond-telemedicine-and-transform-health-care/?sh=6f665efb185e

[7] https://medcitynews.com/2020/09/weve-failed-in-chronic-care-management-its-time-to-change-course/

[8] Ibid.

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