How Value-Based Care Adapted to COVID-19

The pandemic has presented unprecedented challenges for the healthcare system. These challenges are especially difficult for primary care providers and value-based care. Crises can create opportunities. In healthcare, the pandemic has opened the opportunity to bring together insights and knowledge and make vital, lasting reform to the healthcare system.

A community-wide distress

Throughout the pandemic, practices have seen their revenue streams slow as stay at home orders and fears of infection keep many patients away from the office. The widening gap between patients and providers had a major impact on population health and the savings of value-based care providers. Revenues kept dropping, and dire situations pushed primary care providers into new frontline roles to fight the pandemic.

During the pandemic, telehealth, population health, and patient monitoring have changed from initiatives with potential into essential capabilities for effective and impactful care delivery. These tools have assisted providers who have been largely hit during the pandemic. Emergency stimulus packages from the federal government have provided some relief for them, but these will likely prove to be stopgap measures that will not solve the more fundamental challenges posed by the pandemic.

To better fight the pandemic, CMS addressed several issues in its April 30th Interim Final Rule. Changes such as removing all COVID-19 costs from calculations of shared savings and counting telephone visits towards attribution will help repair healthcare in the long run. However, the direct impact of newer technologies is already changing the landscape of value-based care.

Telehealth: How will it progress?

According to CMS, more than 9 million Medicare beneficiaries received care via telehealth between mid-March and mid-June, as stay at home orders and fear of infection kept many patients out of the office. This unprecedented shift in care delivery was made possible by the expansion of reimbursement for telehealth services spearheaded by CMS.

One major challenge with telehealth is the initial set up cost. While the FCC offered $200 million worth of grants, few of our providers were able to access this money. ACOs, especially those considered low-revenue, should have access to an ACO Investment Model (AIM) style program that helps cover the initial cost of getting set up with telehealth. CMS just announced an AIM style program called CHART for rural ACOs but a more extensive plan will help long-term adaptation of telehealth.

Connected Care at all Times with Patient Monitoring

Patient monitoring, along with value-based care, has grown increasingly important during COVID-19. ACOs, by design, thrive by being proactive about their patient’s health and are the forebearers of value in care.

The relationship between certain chronic health conditions and severe COVID-19 has been well documented in recent months. For this reason, chronic care management (CCM), principal care management (PCM), or remote patient monitoring (RPM) can play an important role in keeping patients’ illnesses controlled even when they can’t see their doctor. By managing a patient’s chronic conditions, we can decrease the risk of patients experiencing complications if they are infected with COVID-19. Additionally, CCM can help keep patients out of the hospitals, freeing up hospital resources to treat patients with acute illnesses, such as COVID-19.

Moving forward, the incentive to improve patient health and transitioning to connected care will result in a rise in the usage of remote care tools. Providers in value-based arrangements have a strong financial incentive to monitor chronic conditions and take high-value steps to improve the patient’s condition. Additionally, value-based models can free practices to provide services that create healthcare value but are not reimbursable by CMS or other payers.

Conclusion

There have been some devastating effects of the pandemic on the healthcare system, and major weaknesses have been uncovered. On the other hand, COVID-19 has amended quality reporting requirements for ACOs, reduced their downside risk, and excluded costs attributed to COVID-19 from shared savings calculations. These actions justifiably alleviate some pressure from hospitals dealing with COVID-19. Moving forward, the intent is to create a more effective care response and empower primary care doctors with cutting-edge technology to do what they do best, provide high-quality care to those in need.

Take a look at how Inovaccer’s FHIR-enabled data activation platform is bringing telehealth and remote monitoring to one platform for improving value-based care outcomes here.