Oct 22 2021

HLTH 2021: Reimbursement Flexibility Is Key to Digital Health Innovation

Regulation rollbacks increased virtual care adoption during the pandemic, and more reimbursement freedom could take digital transformation even further.

With the pandemic came a need to reach more patients remotely than ever before. To address this need, Congress passed the Coronavirus Aid, Relief and Economic Security Act, which granted authority for the Centers for Medicare & Medicaid Services (CMS) to provide flexibility for Medicare telehealth services through waivers.

This flexibility led to increased adoption of virtual care technology and innovation in digital health. During HLTH 2021, speakers discussed how regulations impact digital health innovation and what the future of virtual care reimbursement could look like.

CMS Flexibility Impacts Digital Health Innovation

Carrie Nixon, managing partner at Nixon Gwilt Law and moderator for the HLTH 2021 session, titled “The Evolution of Reimbursement,” started off the discussion by asking how payment policy facilitates innovation in digital health.

“Before the pandemic, we had guardrails placed by Congress, likely because of the potential cost. Telehealth was only for established patients and only for certain types of visits,” said Dr. Marion Couch, senior vice president and chief medical officer at Cambia Health Solutions and former CMS senior medical adviser. “By rolling back regulations, approximately 80 more services become available. It’s helped transform acceptance of digital health and telehealth.”

Greg Deavens, president and CEO of Independence Blue Cross, emphasized the importance of the waivers and of flexibility for CMS.

“Going forward, from a legislative standpoint, I hope there’s more flexibility provided to CMS and other bodies to make sure they have the ability to modify how business is done and how payers and providers interact in order for us to take advantage of the technological advances coming at us quickly,” he said. “Having the flexibility to adapt the system quickly is critically important.”

A Post-Pandemic Strategy for Telehealth

In many ways, the pandemic was the catalyst for innovation. Couch said that her hope is that with new services and providers available, the healthcare industry will exit the pandemic with a better understanding of where telehealth is valuable.

Deavens said reimbursement rates for telehealth visits should be closer to those for in-office visits to maintain telehealth use long term. Part of the reason telehealth reimbursement was so much lower than for in-person care is the use of office resources. However, other factors play into the value of telehealth, such as the ease with which patients and clinicians can set up and access appointments.

HLTH reimbursement session

Greg Deavens, president and CEO of Independence Blue Cross, emphasizes the importance of the emergency waivers for increased telehealth adoption.

“We learned that the number of people making appointments and canceling has gone down. More people are proceeding with appointments, though they’re not consuming the same level of services that they do with in-person visits,” he said. “Those differences in cost need to be recognized, but reimbursement probably needs to be closer together than before the pandemic.”

While many physicians and healthcare organizations embraced telehealth quickly, especially large systems able to invest in the necessary resources, heightened adoption highlighted that a lack of broadband access still exists for many communities. Deavens pointed out that some healthcare organizations used mobile vehicles to connect those communities with testing and vaccination services.

“We’re very committed to improving health equity, and getting telehealth to rural communities is huge,” added Couch. “I hope we don’t lose sight of that going forward. A remote consultation for someone in a rural community could be a huge lifesaver, moving up the time of treatment by weeks.”

RELATED: Find out how telemedicine requirements and policies will change post-pandemic.

How Data Facilitates the Transition to Value-Based Care

The healthcare industry mostly operates under a fee-for-service model, but a shift to value-based care is happening gradually. Couch said that the ability to share dashboards, analytics and actionable data would help the industry move toward value-based care.

“Data sharing is critical,” added Deavens. “The sharing needs to be bidirectional.”

He explained that data is important to understanding what factors lead to savings, improvement or deterioration, whether that involves a patient’s primary care physician or a specialist. Being able to share data in the broader healthcare ecosystem can help achieve that goal and aid in the transition to value-based care. Data sharing can also help healthcare organizations identify larger population trends in their communities to improve patient outcomes.

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