Year: 2020
Type: article
Abstract: The coronavirus disease 2019 (COVID-19) pandemic has driven clinicians and organizations around the country to expand their telehealth capabilities.Video and audio services were critical early in the pandemic, when individuals delayed in-person care and health care practitioners halted nonurgent services, actions that collectively plummeted clinic and hospital visits.Although in-person care recovered in the following months, telehealth has remained a critical tool while clinicians faced multiple waves of COVID-19 surges.These dynamics highlight how telehealth will remain a key element of patient care going forward, both in future waves and after the pandemic ultimately subsides.In particular, telehealth may play an increasingly important role in alternative payment models (APMs) that are designed to improve quality and contain costs through better coordination.Telemedicine increases clinicians' ability to work together and with patients to coordinate care-an overarching goal of APMs.Policy experts have increasingly recognized telemedicine's potential impact on APMs, with groups like the Physician-Focused Payment Model Technical Advisory Committee and the Medicare Payment Advisory Commission dedicating time to the topic in recent meetings.In this article, we use 3 examples to illustrate this potential, highlighting how telehealth can enhance strategies that have shown promise or established benefits in APMs. Improving Primary Care AccessBetween 2012 and 2016, Medicare used the Comprehensive Primary Care (CPC) initiative to encourage practices to implement 5 functions of comprehensive primary care, including access and continuity.Although a formal evaluation of CPC did not demonstrate cost savings or quality improvements in many areas, practices participating in CPC did exhibit slower growth in emergency department visits than nonparticipating practices.1 While exact mechanisms remain unclear, existing evidence supports the possibility that lower emergency department visits could be associated with expanded access, a benefit observed in primary care innovations in the United States and the United Kingdom.2,3 In future APMs, policy makers can use telehealth to explore the promise of reducing acute care utilization via expanded primary care access.Historically, efforts to increase access have been resource intensive, requiring expanded staffing and operations.Telehealth strategies, such as on-demand visits, text-based symptom surveillance, and remote monitoring, could expand access more cost efficiently.Telehealth could also expand access in ways that are more upstream (eg, identifying patient symptoms before they become severe enough to require in-person care) and patient centered (eg, increasing access without rearranging schedules, finding transportation, and making appointments).To achieve this potential, APMs must create quality measurement and incentives around telehealth, not simply encourage its use.Even though CPC provided participants with the flexibility to use telehealth, it was not featured prominently in the program.One way would be to emphasize telehealth among individuals for whom evidence of benefit is greatest, such as among those with mental health conditions or chronic disease and high risk of acute care utilization.4,5 Another way would be to tie telehealth to financial incentives, such as a portion of a per-member-per-month
Source: JAMA Health Forum
Authors: Joshua M. Liao, Amol S. Navathe
Language: English
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $5,000
Funders: U.S. Department of Health and Human Services, Robert Wood Johnson Foundation, Commonwealth Fund, Patrick and Catherine Weldon Donaghue Medical Research Foundation, CIGNA Corporation, Pennsylvania Department of Health, U.S. Social Security Administration, Yale University, Cleveland Clinic, Hawaii Medical Service Association, Oscar Health, Ochsner Health, National University Health System
OpenAlex ID: W3113241659