Many providers relying on fee-for-service to drive revenue in 2020 found that during the pandemic, they weren’t getting paid. Meanwhile, those participating in models that fixed payment per member per month saw their cash flow remain steady, according to Lynda Rowe, senior advisor, Value-Based Markets, InterSystems.
Those receiving payments based on in-person visits realized, “It really would have helped our margin if we had seen continuous funding coming in through a capitated model.” Rowe said.
As capitation and other value-based payment models become more common, providers are beginning to rely more heavily on technology to help bridge the gap between fee-for-service and alternate payment models that emphasize quality care.
Shifting from Treatment to Prevention
Digital health tools like telemedicine and remote patient monitoring are playing a key role in encouraging the transition from treatment to prevention, a pillar of value-based care. That’s a key takeaway from a Medical Group Management Association (MGMA) medical practice trends report, which finds that with Medicare and Social Security trust funds quickly draining, “policymakers will look toward leveraging new technology and data and focusing on prevention as necessary first steps to bending the cost curve in healthcare.”
With 90% of the $3.5 trillion annual expenditure in U.S. healthcare spent on people with chronic and mental health conditions, the pressure to reduce cost in this area is high. Fortunately, according to MGMA, “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,” their report says.
Reimbursement Key to Continued Tech Adoption
Physicians echo the MGMA’s prediction, pointing to reimbursement as a critical factor to building on the progress made in technology adoption since 2020. For example, remote monitoring devices can help patients partner more closely with their doctors to prevent deterioration of their chronic conditions by allowing the at-home collection of vitals such as blood pressure, heart rates, and electrocardiograms. However, with remote monitoring devices ranging from $40 all the way up to more than a $1,000, insurance coverage will be vital to ensuring these technologies can benefit the most patients.
Prevention Also Requires Patient Compliance
Telemedicine opens a new world of physician-patient partnerships in managing chronic conditions. Instead of sending a patient home with a care plan and waiting six months for a follow-up visit, telecardiology opens a pathway to the real-time, remote treatment of heart disease.
Cardiac rehab provides an example. The program is “the only intervention that changes outcomes,” according to Robert Berry, clinical coordinator of cardiac rehabilitation at Henry Ford Health System (HFHS). Unfortunately, only 25 percent of patients follow the prescribed regimen. But the system’s telemedicine approach eliminates the logistical challenges patients face in keeping regular appointments. Cardiology patients can use an app to connect via video to their provider using their phone or tablet and complete their rehab remotely. This sort of telemedicine can proven especially helpful for rural residents who, without this option, lose work pay and hours of travel time returning for regular appointments.
Could healthcare finally be turning a corner toward the prevention of disease onset? As technology continues to improve and adapt itself to the needs of the industry, the future looks brighter.