While the pandemic undoubtedly spurred the dramatic increase in telehealth adoption among payers and providers this year, most health care leaders agree that this new normal has become so integral to the member experience that there is no turning back.
Many payers are now adopting telehealth to accomplish a variety of objectives tied to enrollment and revenue growth. Here are 10 key areas of focus for Medicare Advantage (MA) plans in the coming year and how telehealth can help solve them.
All you need to do is turn on the television at this time of year to hear about all the competing MA plans that are trying to attract your member during the “only chance they get to change plans this year.”
With so much competition in the MA landscape, you need to be at the top of your member retention game; offering covered services via telehealth is now more of an expectation than a nice-to-have member benefit.
2. Maintain or raise Star rating to 4 or 5 stars.
Under CMS Star Ratings, plans need to achieve 4 or more stars to receive a five percent bonus payment. Starting next year, the patient experience, access to care and member complaints category will start to shift from a weight of one to four over the next three years. Telehealth appointments offer quicker, simpler access to care for all; even among the 65+ population, members enjoy telehealth. Among older adults who had telehealth visits in Spring 2020, 91 percent said accessing their doctor virtually was an easy experience.
The CAHPS Health Plan Survey — the AHRQ’s measure of member experience — asks members to rate their experience with communication and access to care. Telehealth offers payers a chance to communicate in the way members prefer to in their daily lives — digitally — making it essential to a seamless member experience and broad access to providers for many of the most common doctor visits. In the age of COVID, many members will prefer remote visits whenever possible to eliminate the possibility of entering situations where they might be infected.
HEDIS, the NCQA’s measure of plan performance, looks at utilization, outcomes, access, experience and more. Like CMS, the organization is focused on telehealth and updated HEDIS measures this year to better align with the new wave of virtual care. Plans can leverage telehealth visits to improve their performance on these key measures.
Annual risk assessments are a critical opportunity for your plan to update member conditions and ensure you’re getting the right reimbursement for member care. Telehealth gives plans yet another avenue to drive these visits, at a lower cost yet without losing efficacy. The added convenience makes it easier for members to “visit” and for doctors to assess more patients.
Since the start of the COVID-19 pandemic, Medicare plan member interest in telehealth has increased from 5% to 20%. COVID-19 infections are expected to continue to rise this winter, and some of your older plan members continue to delay care due to concerns about the safety of in-person visits. Virtual visits will help you ensure that members feel cared for and have access to care under their plan by allowing some care to happen remotely.
Plans can encourage their provider networks to use telehealth for quick virtual visits when it’s unclear if a specialist visit is necessary. And providers can be encouraged to use telehealth services for eConsults with other providers to receive guidance on patient care. Either case allows for more efficient, value-based care.
On the flip side of reducing unnecessary care is identifying urgent health issues before they worsen. Offering virtual visits can, in many cases, allow a member to see the doctor sooner. It goes without saying that when your plan can identify patients in need of urgent care faster, you have a better chance of reducing ED visits and admissions, improving health outcomes and saving on the total cost of member care.
Any telehealth software you use should display related clinical notes in the same view where the appointment takes place. Giving providers convenient access to see clinical data right in the same interface makes for a more streamlined appointment experience. Also important: specialists should have the ability to take notes during the appointment and send the information back to their EMR as well as to the referring provider to let them know the appointment was completed successfully and what happened, closing the loop on patient care.
Written by Vytas Kisielius
Vytas has a long career building successful companies in many different capacities across the financial, IT and healthcare sectors. As ReferWell’s CEO, he works tirelessly to ensure ReferWell thrives within the market. Vytas draws on his extensive experience in creating a cohesive, hard working team while building and executing a focused strategy aimed at leading the way in revolutionizing healthcare delivery.