The Future of Value-Based Care Post COVID-19

Value-Based Care Post COVID-19 AuthorRobin LloydAs the healthcare community continues to grapple with the coronavirus pandemic, the scope and nature of this crisis’ longer-term impact on the future of value-based care, including care delivery, policy, and technology are rapidly becoming clear. Necessary evolution in payment models, care delivery, and patient engagement are happening at unimaginable speed, and our assumptions of what is possible are being irrevocably altered.

Expect a virtual stampede to value-based payment models. For just about everyone besides infectious disease specialists and pulmonologists, the calculus between fee-for-service and value-based care models has been irrevocably altered toward the latter. COVID-19 is the third deadly, highly contagious, respiratory illness to break out in the past 18 years, and the risk of another wholesale disruption of patient encounters is not viable for virtually any provider organization to bear. While the full financial impact on various types of providers will not be known for months, it is almost certain that providers with the highest ratio of capitated members will fare the best. All providers will likely seek to expand the share of revenues derived from capitated, value-based care payment models as a new backstop against instability.

Telehealth is transitioning overnight from a promising but shunned technology to a vital, permanent vehicle for care delivery; embraced by CMS and other payers for diagnosis and treatment of risk-adjustable conditions. Previously, CMS policies regarding the validity and application of telehealth visits have been sufficiently ambiguous that only some health plans risk adjust based on telehealth encounters. The rapid deployment and steadily increasing use of telehealth tools compelled CMS to issue its April announcements clarifying its applicability to MA, Cost, PACE, and Demonstration Organizations. CMS, payers, patients, and providers all now have a shared interest in making telehealth a more prominent component of patient care. And many of the most potent objections among these constituencies—inconsistent applicability of telehealth, inadequate documentation, competing technology priorities, physician training and learning curve, patient/consumer comfort with videoconferencing as a replacement for in-person interaction—are being rapidly mitigated out of pure necessity. For at least the next several months, telemedicine will be utilized everywhere it can conceivably provide value.

We will emerge from COVID-19 far further down the curve of virtual care evolution than we ever could have imagined, armed us with a wealth of practically derived data about what works and what doesn’t. While the circumstances are horrible, the pressure applied by the novel coronavirus is driving CMS to align reimbursement levels, tune quality measures, and apply the appropriate amount of compliance oversight. With health plans and providers alike suddenly able to generate substantial cost savings while maintaining or improving outcomes—through more preventative interventions and more attentive management of chronic disease—the last thing CMS will want to do is slow what has long been seen as a game changer in the efficiency of our healthcare system. Broad swaths of conditions will be eligible for telehealth-based diagnosis and treatment, aided by. . .

Wearables graduating from consumer health curiosity to standard, near-universal mechanism for gathering and assimilating patient diagnostic data. One of the curious, oft-cited objections to telemedicine has been that, “You can’t get people’s height, weight, temp, and blood pressure over video.” True, but you can easily capture and transmit them over any of a multitude of low-cost, widely available devices. Look for health plans and risk-bearing providers to subsidize the proliferation of smart thermometers, connected scales, heart-rate and blood pressure monitors, and pulse oximeters. It’s not unreasonable to expect device manufacturers to accelerate their data security and HIPAA compliance efforts to ensure captured data can be confidently and broadly incorporated into condition diagnosis, wellness monitoring, and care plans themselves. At the same time, expect a battle over how this data is gathered and used by payers; none of us wants to feel as though we’re wearing the healthcare equivalent of Progressive’s Snapshot. Privacy issues aside, remote diagnostic tools will see a great boost alongside adoption of telemedicine.

The path through the COVID-19 crisis is still far from clear, and its impact is already devastating to many. But profound and durable innovation is already being achieved. Our challenge at Health Fidelity is to support both payers and providers as we all adapt to this shifting landscape.

Natural language processing technology will remain essential for its unique ability to assimilate new sources of clinical data, unstructured transcripts of telehealth visits, for example, or a stream of diagnostic data from wearable, connected devices, all at scale. Our solutions derive condition insights via NLP and deliver them effectively into evolving care and risk adjustment workflows, powering the coming acceleration in more cost-effective, high-performing, value-based care.