However it is labeled - virtual Health, telehealth or digital care delivery - the ability for millions of Americans to get the care they needed while observing stay-at-home orders and protecting themselves from exposure has been a game changer for every healthcare system stakeholder during the COVID-19 crisis. Out of urgency, Telehealth has focused on the clinical dimension of care, but for financial sustainability after the crisis providers will need to expand their concept of virtual care to include systems that empower patients to pay.
When the COVID-19 national emergency was proclaimed on March 13, 2020, emergency authority was granted to the secretary of the Department of Health and Human Services (HHS) to “waive or modify certain requirements of the Medicare, Medicaid and State Children’s Health Insurance programs…in response to the pandemic.” Shortly afterward, on March 17, the Centers for Medicare and Medicaid Services (CMS) published a fact sheet outlining special provisions the agency had made “so that beneficiaries can receive a wider range of services from their doctors without having to travel to a healthcare facility.”
Industry experts all agree that the last few months of dramatically accelerated telehealth development would never have happened without this regulatory support. The waivers that have temporarily assured pay parity and enabled physicians to deliver care across state borders have been and will continue to be essential to the growth and sustainability of virtual care delivery. Further, they believe that government has an important role to play in making high-quality Internet connectivity available to everyone. More than ever, access to the Internet is a social determinant of health, especially for underserved communities. The infrastructure to support this access demands state and federal support.
As important as regulatory support and infrastructure improvement are to the continued advancement of virtual care, telehealth must now expand to include other dimensions of patient care. This is especially true with the financial dimension of care because of its outsized influence on patient behavior and provider operating performance. In our experience working with large healthcare providers across the country, an integrated virtual care experience includes each of the following tested and proven elements.
- Transparency - An upfront presentation of a reliable treatment cost estimate - both what the insurer is expected to pay and what the patient will be responsible for
- Affordability - Multiple, personalized payment options for patients without the means to pay their portion - to include incentives for prompt or early payment, interest free payment plans and third-party financing
- Omni-Channel communications - Throughout the care journey, beginning when appointments are set, throughout the clinical care episode and concluding with billing and payment - timely, respectful communications using the patient’s preferred channel
- One Bed One Bill - Plain-worded bills that consolidate multiple billing entities (hospital, physician, specialist, etc.) into a single, easy to understand and easy to pay bill
- Easy payments - Regardless of the patient’s method of payment, including PayPal and other emerging payment types, real-time payment processing and reconciliation, with complete end-to-end visibility for patients and providers alike
Together, these elements are proving to help providers enhance their delivery of virtual care by lowering the financial barriers that discourage care and impede payment. More importantly, by adding a patient financial engagement solution like Loyale’s Patient Financial Manager™ to their existing telehealth workflows, providers are integrating the two dimensions of care with the biggest impact on patient behavior and satisfaction.
Healthcare Providers and Patients Have Embraced Telehealth
Before the COVID-19 crisis and the ensuing regulatory changes , most providers recognized the importance of developing a more robust digital care delivery capability. But the efforts to build the infrastructure were treated with varying levels of interest and investment and the improvements were generally incremental. Because virtual visits were reimbursed at lower rates than for in-office visits and represented a very small portion of patient encounters, many providers deemed telehealth a low- or non-priority. That all changed suddenly in mid-March when the novel coronavirus turned American’s lives upside down.
In an article contributed to US News by Teshamae Monteith, M.D. titled, “It’s Time to Permanently Expand Telemedicine”, Doctor Monteith writes that “Before the pandemic, telemedicine coverage by neurologists was largely limited, often restricted to rural communities and cases of stroke care. Just a few months before the pandemic, I hesitated to adopt telemedicine because I felt it would not be an equivalent experience to an in-person patient encounter. Now, I’m convinced telemedicine is a valuable option that needs to stay.” He concludes his argument by noting that, “permanent private and Medicare coverage for telehealth services that remove location requirements could help facilitate widespread adoption, especially for communities in need. As we look to the future after COVID-19, we cannot go back to old systems of care that do not work for everyone.”
Many industry leaders agree. In another US News article, “Navigating the Virtual Future of Health Care," contributor Gabrielle Wanneh writes that, “Providers from across the U.S. see great opportunity in care that’s delivered digitally, but challenges remain with costs, regulations and reaching underserved communities.” Reporting on a webinar hosted by U.S. News on July 30, Ms. Wanneh quotes Suja Chandrasekaran, senior EVP and CIO for CommonSpirit Health, a system with over 700 care centers in 21 states. “Prior to the pandemic, providers such as CommonSpirit Health, Atrium Health and Banner Health had already been working on their capabilities of telehealth and other virtual programs." To this, Scott Rismiller, EVP and chief physician executive of Atrium Health described the process at the time as “slow and incremental.”
The unprecedented demand for virtual care during the COVID-19 crisis dramatically accelerated virtual care development among providers everywhere. Atrium Health, for example, “established a COVID-19 virtual hospital in March as a means of providing safe and convenient treatment to patients with the virus who did not need physical hospitalization…the hospital has since served around 12,000 patients and has received a great deal of positive feedback." Banner Health “is on target to complete about 140,000 to 200,000 more virtual visits than they’ve done in the past,” according to James Roxbaugh, CEO.
Fixing Telehealth Economics for Providers and the Patients
As encouraging as the rapid development of virtual care has been, there is a widening gap between the clinical or medical dimension of the patient care experience and the other dimensions that make up the episode of care. In the webinar referenced above, Ms. Chandrasekaran pointed out that within their overall care experience, patients take multiple care journeys. All of them must be integrated seamlessly. We would argue that the patient’s financial experience is the most important place to begin addressing the gap. This is especially important today, when patient choice and ability to pay represent the bulk of any provider’s care-related revenue.
For years before the crisis began, many Americans were already struggling to pay their portion of medical bills. Between high deductible health plan premiums, the deductibles themselves and co-pays, out-of-pocket costs had become so burdensome that many either delayed or avoided care. Too often, those who did seek care found themselves unable to pay or to pay on time. As a result, hospitals’ patient bad debt soared and providers were forced to resort to collection methods that sometimes ran counter to their missions and detrimental to their reputations.
The surge in demand for virtual care is easily explained by the social and behavioral constraints placed on patients and providers during the crisis, but - just as providers had already been working on systems for virtual care delivery before the crisis - patients had also begun to demonstrate an interest in alternative models of care delivery. We explored this topic in an article titled "We the Patients: Consumerism, Convenience and Technology." In it, we noted a statistical decline in the dominance of the Primary Care Physician operating model, the rising influence of the patient as healthcare consumer and Americans' ever-expanding comfort with, if not preference for, digital engagement.
To summarize: American healthcare consumers, especially younger ones, are looking for healthcare that’s more convenient and more affordable. For most, the notion of receiving care online was perfectly acceptable. Now, because of the COVID-19 crisis, it seems everyone is on board. According to FairHealth’s Monthly Telehealth Regional Tracker, telehealth claims rose 8,335% for the month of April - the peak of the pandemic. In May, the most recent month with tracking results, the increase moderated to 5,679%. Industry leaders all agree, COVID-19 has been a watershed event for telehealth.
At Loyale, we’re convinced that the future of healthcare will depend on a provider’s capacity to engage with its patients digitally. As a fundamental addition to its brick-and-mortar operations, telehealth will expand provider markets, improve patient access, ensure care timeliness and ultimately reduce costs for all. By integrating both medical care and financial care, patients will have the confidence they need to get - and pay for - the care they need. That’s a future we think everyone can get excited about.