Accountable care organizations are racing to implement telehealth and remote patient monitoring to coordinate care and stay afloat financially during the COVID-19 outbreak, a new survey found.
The survey of 20 ACOs led by researchers with Hamilton College and Within Health, a startup that helps ACOs with radiology workflow, explored strategies that ACOs are using to mitigate shared losses and how they plan to weather the financial crisis caused by the outbreak.
Half of the ACOs surveyed expect that preventive health measures will be the hardest to meet due to COVID-19. Under the Medicare Shared Savings Program, an ACO must meet a series of metrics that include preventive health screening for smoking, cancer or vaccines to get a share of any savings.
ACOs are on the hook for paying back Medicare if they don’t meet spending or quality targets, but also get a share of any savings they generate.
However, with COVID-19 throwing a massive wrench into healthcare utilization and spending, ACOs are forced to readjust their projections.
The survey found that a quarter of ACOs are abandoning the financial risk model altogether and moving towards traditional Medicare fee-for-service because they can’t hit the quality metrics, said Kareem Malek, the chief operating officer for Within Health.
“They are focused on bringing in revenue on fee-for-service and billing Medicare for reimbursable expenses like telehealth and in-home monitoring,” he said. “Some ACOs are going as far as to renegotiate or terminate contracts with vendors and providers.”
All respondents said they are implementing telemedicine solutions, with 16% relying on AI and automation to identify and reach out to high-risk patients.
The Centers for Medicare & Medicaid Services has waived certain telehealth payment requirements to be better enable such services.
“Every single ACO is implementing a telehealth solution, particularly platforms with strong specialists already integrated,” Malek said.
ACOs are also revisiting their operating model to shift resources and reduce headcount, the survey found. All of the ACOs are also pressing CMS to mitigate shared losses for not just 2020 but also 2021. Another 58% suggested extending deadlines for submitting quality reporting data.
CMS has provided some regulatory relief for ACOs and other value-based care programs. The agency also will not use quality data on services performed from Jan. 1 to June 30 in the calculations on quality reporting and value-based purchasing programs.
The agency also extended the deadline for both ACOs and physicians in the Merit-based Incentive Payment System for submitting 2019 data from March 31 to April 30.
But ACOs are asking for a mulligan for the entirety of 2020 from repaying any shared losses, which CMS declined to do.