What health plans must know about telehealth’s immediate impact on risk adjustment

The coronavirus pandemic has disrupted so many elements of our healthcare system that it’s onerous to understand the entire second- and third-order penalties. One space being hit significantly onerous is risk adjustment since conventional retrospective and in-home packages are usually not viable within the present setting.

Within the early innings of the Covid-19 disaster, CMS carried out many initiatives in response to the nationwide emergency declaration, however risk adjustment was notably left unaddressed. This created plenty of anxiousness amongst health plans and different at-risk entities given the significance of precisely risk adjusting a plan’s membership. The trade’s hope, on the time, was that CMS would construct on its sequence of telehealth waivers from March to permit health plans to assemble risk adjustment knowledge by way of telehealth visits.

That grew to become a actuality in April when CMS approved telehealth as a method for health plans to assemble risk adjustment knowledge. CMS made the precise transfer, as it’s important for Medicare Benefit (MA) plans—which insure most of the oldest and sickest sufferers—to remain on observe with risk adjustment. Moreover, to the extent that the risk adjustment resolution is provider-centric, it permits main care physicians (PCPs) to uphold high quality and tackle care gaps by way of preventive and routine care.

Nevertheless, rolling out a telehealth risk adjustment resolution isn’t so simple as flipping a swap. Whereas telehealth has seen explosive growth for youthful customers, many PCPs and seniors nonetheless face obstacles in adopting and integrating new expertise and workflows. These challenges are compounded by ever-changing regulatory necessities and unprecedented monetary stress threatening the continuing viability of PCP practices.

Luckily, there’s a path ahead. There are a few challenges that health plans can tackle which is able to allow them to implement profitable risk-adjustment initiatives throughout Covid-19.

Fixing for disjointed telehealth methods
Telehealth utilization is growing however perhaps disjointed between audio and video strategies and exterior telehealth options. In an effort to capitalize on the telehealth risk adjustment waiver, visits by way of phone solely won’t be sufficient. CMS has acknowledged that PCPs can solely collect encounter knowledge for risk adjustment by way of real-time interactive audio-video telecommunication methods.

Moreover, many outsourced telehealth options use clinicians with no relationship to sufferers or connectivity to a PCP’s EMR. Whereas such options could also be efficient to deal with acute wants when a affected person’s PCP is unavailable, they shouldn’t be an alternative to a PCP-centric telehealth resolution for risk adjustment and care coordination. Outsourced telehealth options will probably be ineffective and trigger vital supplier abrasion at a time when PCPs are struggling to maintain their practices open.

Throughout this time, PCPs want options that maintain them productive and engaged with their sufferers, relatively than creating extra work choosing up the items of an outsourced telehealth resolution. PCPs additionally want assist implementing this new care supply mannequin into their workflow.

Serving to strained and under-staffed PCPs by driving member engagement
As coronavirus care impacts all elements of our enterprise and private lives, PCPs are underneath appreciable stress, and their monetary viability is being threatened. A survey of physicians in mid-April revealed that patient volumes are down 65% in comparison with pre-pandemic volumes, and the consequences are starting to catch as much as the PCP practices. Some practices have already decreased their workforce, and others suppose they’ll need to briefly shutter their doorways.

Although telehealth is now an choice, practices nonetheless need assistance getting sufferers to take part. PCPs want easy-to-use member engagement instruments with administrative and scientific assist to safe affected person participation. To optimize participation, health plans can promote PCP-centric telehealth to the members. Not solely can this assist preserve risk adjustment packages, nevertheless it additionally helps PCPs to generate reimbursable income at a time when it’s wanted most.

Whereas dealing with these two challenges will assist MA plans within the close to time period, the true query is, “The place can we go from right here?” Whereas it’s onerous to think about that telehealth will ever totally exchange in-person care, we anticipate that it will likely be our “new regular” for fairly a while. That is very true for seniors who’re on the best risk of problems from Covid-19. I’m cautiously optimistic that telehealth will stay in place for routine and preventive care and, if it does, we might anticipate CMS’ new steerage on risk adjustment by way of telehealth to even be prolonged.

Within the meantime, health plans ought to assist their PCPs combine telehealth into their follow to take full benefit of the brand new guidelines and adaptability regarding telehealth and risk adjustment throughout Covidh-19.

Photograph: Sylverarts, Getty Photos

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