The COVID-19 pandemic has created a seismic shift in the healthcare industry. Primary care practices are projected to lose an estimated $65,000 in revenue per full-time physician this year and an estimated 8% of practices have closed under the pandemic’s weight.
Those struggles are likely to continue well into next year. With virus concerns and logistical issues forcing many people to delay or avoid medical care, providers have not been able to conduct the visits that are needed to ensure accurate Medicare Advantage risk adjustment payments.
As a result, risk adjustment payments may fall by 7% or more in 2021 compared to 2020. That will make it difficult or impossible for healthcare providers to recoup this year’s losses. And with many clinicians being forced to prioritize their most high risk or sickest patients, the cycle of inaccurate risk adjustment payments could linger into 2022 as well.
Video-based telehealth solutions
Video-based telehealth has proven to be an effective way for clinicians to conduct visits that meet the requirements for risk adjustment reimbursement set by the Centers for Medicare and Medicaid Services. Unfortunately, the seniors with the highest risk scores often have the hardest time accessing technology for remote-care services.
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Consider that 38% of adults over age 65 have difficulties with telemedicine visits, or that 72% of individuals 85 and older lack the experience necessary to participate in video visits. Additionally, there are a number of reasons that seniors struggle with using technology. In most cases, it is because solutions are designed with younger patients in mind and these design elements leave many seniors out in the cold.
According to the New England Journal of Medicine, many clinicians also struggle to use complex telehealth platforms and report having trouble explaining check-in procedures to patients, using interpreter services, and even delivering video equipment to clinicians’ homes.
Overcoming these obstacles is key to fully maximizing the potential of telehealth for Medicare Advantage patients. Here are three features to look for in a telehealth solution that meets the needs of clinicians and patients alike.
- Always-on connectivity. A telehealth solution is only effective if patients can use it and a lack of reliable internet access is a major hurdle to achieving consistent utilization. Consider the fact that 49% of seniors lack at-home broadband access. That means solutions that rely solely on WiFi exclude nearly half of senior patients. So, when selecting a technology solution, look for options that offer both WiFi and a built-in LTE connection to ensure always-on connectivity.
- Engaging interface. Seniors struggle with traditional smartphones and tablets for a number of reasons, but the underlying issue is that such devices simply are not built with older users in mind. The screens aren’t bright enough, the speakers aren’t loud enough, and the touchscreen doesn’t always respond to dry skin (which is a natural part of aging). Patients of all ages are unlikely to participate in virtual visits if the technology is not easy to use, so select tools that offer a simple and appealing interface purpose-built for seniors.
- Seamless integration and admin tools. Video calls are effective for assessing a patient’s general condition because this technology enables providers to see and hear their patients, assess their movements, even gain insights from their environment. But to ensure adoption by clinicians, telehealth solutions need to integrate seamlessly into existing workflows and provide added value. For example, while increasing completion of virtual visits is a primary success factor, look for telehealth solutions that enable enhanced data collection through connected devices and that provide reporting that can improve care delivery and that directly ties to risk adjustment factor scores.
Telehealth use has grown dramatically during the pandemic, with providers seeing 50-to-175 times the number of remote patients than normal.
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Meanwhile, consumer use of telehealth has grown from 11% of U.S. consumers in 2019 to 46% this year.
Not only does this fundamental shift in the way patients access care present opportunities for clinicians to ensure continuity of services and patient outcomes, but it supports greater accuracy in Medicare Advantage risk adjustment payments, which translates to a healthier bottom line for healthcare provider organizations.
Mark Galloway is chief commercial officer for GrandPad and Nathan Vogt is director of strategic accounts.