As a significant portion of care encounters have shifted to the virtual environment, it is the responsibility of providers and payers to ensure their patients and members are not lost in this shift.
Payers and providers have worked diligently over the past few months to quickly expand access to medical advice and care coordination. This rapid change has accelerated efforts by providers and payers to transform their workforces and processes to better deliver and cover remote care solutions. Plus, it has forced payers to more quickly adopt reimbursement structures that appropriately compensate physicians for care.
As it appears this shift will become more permanent, these partners need to ensure incentives and priorities are aligned so that all patients are able to access convenient, safe and effective care. Experts at Envolve Health, a comprehensive healthcare solutions provider, have identified four strategies for payer-provider collaboration on this critical topic.
- Collaborate to coordinate care, better manage chronic conditions and ensure medication adherence.
Payers and providers agree when chronic conditions are properly managed, outcomes are improved, care is more efficient and unnecessary costs are avoided. On this key area where payers and providers can find common ground, there is a clear opportunity—and impetus—for leaders to work together to prevent adverse outcomes. Diabetes is one of the most significant chronic illness priorities for payers and providers, impacting over 34 million Americans, according to the American Diabetes Association. A 2017 UK study found that a third of diabetes patients don’t take their medication, risking major complications such as eye disease or kidney damage. Payers and providers have a common interest in investing in and encouraging adoption of remote monitoring and virtual visit technology, to monitor patients’ glucose levels, ensure medication adherence and offer relevant medical advice.
“Telehealth can be a way to reach out to patients to make sure they’re taking medication and able to access care,” said Dr. Frank Crociata, division medical director at Envolve Health. “When you increase access to care, you’ll hopefully decrease utilization of the emergency room, a major cost-driver. If we reduce complications because patients are taking medication, we’ll do better in the long run as well.”
Medication adherence is critical to the management of chronic illnesses, especially during the COVID-19 pandemic. Many people have chosen to stay in their homes and limit their times in public places—especially vulnerable patients, such as older adults. Active telephonic outreach and medication delivery options highlighted on health plan member portals have been a great way to ensure individuals continue to take, and receive their medications. Many medication adherence programs include timed outreach and engagement with members. These outreach efforts on both the payer and provider side have been amplified to ensure individuals know what their options are in terms of receiving their medications. Payers should also consider encouraging their members to enroll in monthly home-delivery of maintenance medications and further promote adherence programs and assistance through nurse advice lines, customer service centers and online.
- Work together to ensure that vulnerable patients and members have access to technology so that they can utilize virtual care.
While telehealth adoption is at an all-time high, payers and providers must not forget about underserved populations. Both partners play a critical role in ensuring access is available to vulnerable patients and members, such as older adults and low-income Americans, who may have difficulty accessing virtual services. Payers and provider partners should collaborate in assessing patient needs and supporting them with care coordination and training on using telehealth technology. Partnering with community organizations and local institutions to either provide or subsidize devices and Internet access is one way to ensure patients have the equipment and knowledge to seek virtual care.
Leaders should consider the importance of investing in vendors and technology that allow for easy access without adding additional steps that are difficult for the patient to achieve before being able to access care.
Even if patients don’t have access to a smartphone or computer, most will have access to a basic phone. A Nurse Advice Line can serve as a valuable way for patients and members to ask for help—payers and providers should invest in this service and conduct regular communication and outreach about its availability to underserved patients and members.
- Leverage virtual outreach that directs patients to the right care venue.
Just as telehealth is critical in providing access to care in the virtual environment, this technology should also be used to ensure patients obtain in-person care when necessary. During the COVID-19 pandemic, it has become more important than ever to ensure that emergency departments are not overcrowded. A Nurse Advice Line helps support payer-provider goals in directing patients with low-acuity needs to telehealth, urgent care or a primary care physician. At the same time, Nurse Advice Lines play an important role in advising patients with truly emergent cases to seek immediate care in the ED and provides guidance to those concerned with infection risk.
“There is a great deal of panic and fear related to COVID-19,” Crociata said. “Unfortunately, some patients and members are avoiding the ER and foregoing care for things like chest pain. A Nurse Advice Line can triage these symptoms and direct people to seek emergency care if it is necessary, reassuring them about what they should be doing and even calling ahead to alert frontline clinicians.”
- Ensure patients and members are focused on all aspects of their health, including dental and vision.
Payers and providers are increasingly implementing programs that incorporate dental and vision care into their efforts to proactively manage the whole health of their members and patients. Changes in vision that may not have been reviewed at an annual physical can impact other aspects of health, and regular vision appointments are especially important for people with diabetes who are more likely to develop eye diseases, including glaucoma, cataracts and diabetic retinopathy. Similarly, dental appointments can uncover signs of certain disease states like diabetes, heart disease, kidney disease and certain cancers.
To allay fears about COVID-19 exposure, plans and providers should encourage members and patients to either return to the office or make use of tele-dentistry and tele-optometry options that are increasingly available. Virtual care allows for an individual who may be experiencing a problem to speak to their provider and determine how urgent the need is for a vision exam or a dental repair. This can provide comfort to individuals, especially if the recommendation is made by a provider they trust. It’s also crucial that providers leverage virtual outreach to communicate precautions that they are taking to provide a safe environment, such as direct entry to a private exam room, online check-in and copayment options.
Ultimately, if providers are to succeed in collaborating on these significant opportunities to improve population health, financial and quality incentives must be aligned. That starts by having honest, productive conversations about common priorities and values. Payers must ensure they are compensating providers fairly for virtual services, and providers must ensure they are being transparent by providing the same level of detailed documentation they would for an in-person visit, outlining clear justifications for care. With concerns about reimbursement and risk addressed, both providers and payers can agree about the financial benefits and improved health outcomes associated with virtual care: most providers appreciate its ability to attract more patients and most payers understand its potential to provide low-cost, proactive care that can prevent costly complications from untreated conditions.
Crociata noted, “If you align incentives for physicians and payers to improve access, they’ll be more likely to partner knowing that there is a financial incentive to do so as well.”
