The pivotal role of telehealth in value-based care success

Healthcare organizations, including employers, are embracing telehealth visits for low-acuity patient issues as a logical cost management, patient convenience and wellness option. The rise of high deductible health plans has fueled use of virtual care, as patients are often looking for lower-cost care options to traditional in-person urgent care and primary care. MDLIVE reported that patients are increasingly accepting of virtual clinical appointments via telehealth and 94 percent of patients treated report that their medical issue was resolved during a virtual visit.

MDLIVE, a Sunrise, Fla.-based telehealth technology and clinical services provider, hosted an executive roundtable at Becker's 5th Annual CEO + CFO Roundtable Nov. 9 in Chicago, with more than 20 hospital, health system and health plan senior executives in attendance.

The out-of-pocket cost for a virtual visit is usually less than the cost of a trip to urgent care, Sanjay Patil, MD, executive vice president and general manager for health systems at MDLIVE, explained. Millennials also have embraced virtual care, as they expect convenience and affordability in all aspects of life, including healthcare, he said.

Using informed virtual care proactively in value-based care scenarios

Traditionally, virtual care visits have been used in a reactive mode by servicing low acuity, on-demand inquiries from patients in a virtualized urgent care model. With the roll-out of value-based care programs that focus on patient outcomes, health systems and health plans can also use telehealth in a proactive way, reaching out to patients facing transitions in care, closing patient gaps in care and tracking adherence for patients with chronic care management plans.

To drive value with reactive and proactive virtual care, clinicians must have access to as much information about the patients as possible, which MDLIVE calls "informed virtual care."

Virtual care providers need to know the full background of the patient, Dr. Patil said, so the clinician can identify gaps in care and close them. For gap closure to be timely, clinicians need near real-time access to a patient's medical history, including claims, clinical, lab and pharmacy data.

An example of gap closure could involve an informed, on-demand, low-acuity telehealth encounter where clinical, claims or pharmacy-based medical history about a patient indicates a prior diagnosis of pre-diabetes. If the patient history did not indicate that the patient had an HbA1c lab test performed within the last 12 months and, after confirmation from the patient that no lab had been performed, the virtual care provider could order the HbA1c lab, coordinate with a lab to dispatch a phlebotomist to the patient's home or work to draw the blood, interpret the lab results for the patient and refer the patient to an endocrinologist for follow-up as needed.

Using virtual care proactively also means a clinician or care coordinator can reach out to a patient or health plan member, facilitate transitions, take steps to close gaps in care or confirm the patient is tracking to a prescribed chronic care management plan. Equally important, the proactive virtual care outreach creates credible documentation that can be used to assess disease burden and document risk adjustment.

"We envision a new clinical role emerging over time: the virtualist," said Dr. Patil. A virtualist will not be a specialist, but instead work closely with specialists like endocrinologists or cardiologists managing diabetic patients or heart failure patients virtually instead of during an in-person visit. Virtual care is another venue for high value healthcare service delivery.

Driving value-based care metrics with virtual care

There is a "maze" of value-based care incentive programs in healthcare today, Bryan Brewer, MDLIVE's vice president of professional services and health systems implementation, said. Those include the Medicare Access and CHIP Reauthorization Act, accountable care organizations, Comprehensive Primary Care Plus, Medicare Advantage and the Delivery System Reform Incentive Payment Program.

"What all these value-based care incentive programs have in common are metrics that can be addressed cost-effectively by proactive virtual care," Mr. Brewer said. For instance, proactive virtual care could help reduce preventable readmissions, track efforts toward chronic care plan management and document depression screening compliance for patients at or above age 60. Virtual care can also drive performance and quality based physician incentive compensation programs at providers where, in many cases, higher compensation weight is being assigned to value-based care outcomes.

Incorporating an informed virtual care strategy provides more access to lower cost care for low-acuity patient encounters also helps providers and health plans achieve success in the value-based care program environment.

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