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The Payor Perspective



#TelemedNow Twitter Chat Wednesday, August 26 – 8 PM ET Introduction & Welcome: Kristi Henderson (@KristiHenderson) & Jamey Edwards (@JameyEdwards) – Moderators The Payor Perspective Q1 How do #payors view #Telemedicine as part of the larger care continuum? What problem does it solve for them?

A1 Notable Responses: Helen Burstin (@HelenBurstin) I suspect clinicians and payors agree on the problem #telehealth solves - virtual care should be part of the full continuum of care. Patients should get care in person/virtually from clinicians who know them and build on longstanding relationships Ceci Connolly (@CeciConnolly) Our nonprofit members are all in: they view it as a HUGE opportunity to expand access, improve care coordination, provide convenience, and reduce costs. Michael Bagel (@MichaelBagel) #Telehealth is a critical component to transitioning to value-based care. Being able to treat patients where they are and when they need it delivers appropriate and high-quality care focused on value NOT volume. Kristi Henderson (@KristiHenderson) Agree! To achieve a value based care model, #telehealth is essential to engagement, behavior change, disease management and early intervention. Jamey Edwards (@JameyEdwards) From RPM to Case Management, #Telemedicine can play key role in helping insurer’s stay connected to members & support care. #Payors can provide complete #patient historical record at point of care as well as medication knowledge, etc…could be gamechanger Ritu Thamman (@iamritu) as part of value based care-chronic disease care w RPM may lead to behavioral changes that ˅ costs from ˄adherence to Rx & prevent hospitalizations/ER visits, front loading costs Andrew Watson (@arwmd) The ability to interact with members in-between and beyond hospital / offices is invaluable. #TelemedNow https://bit.ly/31xhzPa From 2017 - The use of telemedicine has been shown to allow for better long-term care management and patient satisfaction” = Value ! Evan Kirstel (@EvanKirstel) Health insurers have a vested interest in helping consumers manage chronic diseases and engage in preventive care from home, both during the pandemic and afterwards Nathaniel Lacktman (@lacktman) Only if that member is on the same health plan’s roster for the long haul. Otherwise, that member’s medical spend becomes someone else’s (read: Medicare) cost. Andrew Watson (@arwmd) And I wish #RPM was better proven in this space, of management of chronic disease. Interesting news from @validic this week. Nathaniel Lacktman (@lacktman) Network adequacy requirements. Patient access metrics. Patient satisfaction scores. Cost reduction is a MAYBE Ceci Connolly (@CeciConnolly) Fair enough. But if you score on the first three is cost reduction necessary? Can the ROI be happier, healthier patients? Andrew Watson (@arwmd) Nate, that’s such an important point. Much of the long-term savings aren’t accrued by the same pair, and therefore they may not invest as much in long-term chronic care management Helen Burstin (@HelenBurstin) Agree @iamritu. Chronic care management is critical feature of #telehealth, especially if pts can "see" their own docs who can drive behavior change. Ideally, payors incentivize visits to own clinicians, rather than standalone platforms Lisa Levitt (@llevitt800) 100 agree that payers are exploring how #telehealth can support #VBR. Huge opportunities not only for PATIENT to have more convenience, also #virtualcare facilitates coordination of multidisciplinary care without requiring care team to be co-located Rasu Shrestha (@RasuShrestha) For payors, #telemedicine is not an "add on" or a "nice to have". It's an essential toolkit. A must-have. The way it SHOULD BE for all of #healthcare. Irma (@IrmaRaste) While logically it should make total sen$e, the problem in the US is that majority of #healthinsurance is tied to a person’s employer & so there is no continuity with the patient. Prevention pays big benefits down the road, and might benefit a diff payer. Lisa Levitt (@llevitt800) Consider vendors that offer 24/7 virtual urgent care can help payers reduce costs of "ER frequent flyers" - patients often w/o PCP. Note pre- COVID mixed $$ incentives with VUC vs. capitated HMO. Now hope med groups offer more telehealth options around the clock. #TelemedNow

Poll Q1A: Do payors see greater value in any specific modalities? If so which one? - Video Visits - Asynchronous (Email/Chat) - eCare Management - Remote Patient Monitoring Q2 In terms of strategy, what is long-term view #Payors are taking w/ reimbursement, regulatory advocacy & the future of #telemedicine? A2 Notable Responses: Ritu Thamman (@iamritu) maybe a disconnect of health insurance from employment? reimbursement:biz models either try to replace primary care (focused on chronic care management) or urgent / acute care Payors must strategize their response to the collateral damage of #COVID19 too Helen Burstin (@HelenBurstin) YES! Payors please help! It is crazy that docs/nurses are still filling out these forms (especially since immunizations available in many state-based registries!) Michael Bagel (@MichaelBagel) @_ACHP advocacy efforts are focused on making #telehealth flexibilities permanent. Need to eliminate originating site, open provider licensure and encourage practice across state lines. And let's not forget universal BROADBAND that works! Nathaniel Lacktman (@lacktman) telemedicne and digital health is clearly long term strategy for all payors. all governmental payors reimburse at parity to in-person. Many commercial payors support telemed coverage but not payment parity. Ceci Connolly (@CeciConnolly) Payment parity right now is critical; over time path to value-based model w/ #telehealth as 1 key tool will be best incentive for patients & drs choosing what's most appropriate #TelemedNow Salim Saiyed (@SamlinCMIO) another wrinkle is that they support their own #telemednow platforms versus providers Kristi Henderson (@KristiHenderson) Do you think we are overloading patients with too much technology- everyone has an #app and we are confusing patients and duplicating efforts Ginny Whitman (@GinWhitman) I think there's an argument to be made for consistency or standards to the platforms flooding the market. Decrease the learning curve with new tech for both payers and providers Nathaniel Lacktman (@Lacktman) Consolidation will happen as the industry matures. M&A will combine smaller companies into larger. It’s already been occurring in telemed for years. Now we have a wave of IPOs. Natural progression. Andrew Watson (@arwmd) The main strategy IMO is reducing the total cost of care and unplanned care. #TelemedNow. How can you use access and better chronic disease management to do this? Clearly @HHSGov@CMSSmed are giving us the opportunity to explore this in MC in particular. Ryan K. Louie (@ryanlouie) I wonder if what we're seeing right now in the Payors space is something from the late Professor @claychristensen's #InnovatorsDilemma and disruptive innovation fomo. Ceci Connolly (@CeciConnolly) First area of focus is making sure we don’t roll-back access people now rely on. That includes making @CMSgov flexibilities permanent, but before that also need to make sure #COVID public health emergency is renewed. #TelemedNow Tricia Guay (@TBG_ACHP) And let’s not forget that Congress has a role in making some of the #telehealth authorities permanent. Everyone needs to help keep the momentum of #TelemedNow going for Congress. Connie Hwang (@hwangc01) [Shaking Magic 8-Ball] @_ACHP health plans support legislative efforts to make #covid19 #telemednow flexibilities permanent. Reimbursement is vital but over time will be more nuanced than 100% parity for all services. More value-based contracts promoting telehealth ahead. Aditi Joshi (@draditijoshi) late to party tonight but made it! Partially investing in a long term strategy to save costs and improve patient ability to choose types of healthcare. Before pandemic you saw more of the ‘risk’ portion. Now it’s about recreating the health model Lisa Levitt (@llevitt800) Glad you are here! Great point about the need to recreate the health model. Payers have a role to play in guiding the evolution of how and where care is delivered through their policies for financing health care services Ritu Thamman (@iamritu) This is a key difference ( b/w public & private insurances) & pt preference will drive this: study from the @ClevelandClinic @khaldountarakji shows that once patients & clinicians try #TelemedNow they may prefer it https://www.heartrhythmjournal.com/article/S1547-5271(20)30432-X/fulltext Jamey Edwards (@jameyedwards) Gold standard of #healthcare is no longer the in-person visit. Gold standard is the appropriate modality for the situation. Lisa Levitt (@llevitt800) #TelemedNow agree that payment parity is key. Maybe more states will put in place regulatory requirements like California did last year, as reported by @Lacktman https://www.foley.com/en/insights/publications/2019/10/california-governor-new-telehealth-insurance-law Chad Ellimoottil (@chadellimoottil) Most payors are opposing payment parity for telehealth. Saying you should pay healthcare providers less for video visits is like saying healthcare executives should take a pay cut since most of their meetings are now through Zoom. #TelemedNow Salim Saiyed (@SalimCMIO) we should get reimbursed more during the #pandemic emergency for #TelemedNow Dont need another #meaningfuluse, but is #telemednow ripe for some form of government incentive program ? Eric Gombrich (@EricGombrich) Do you think there is fear from #payors of over-use because of convenience? #TelemedNow Jamey Edwards (@jameyedwards) @KristiHenderson. Thoughts here? We hear about "overconsumption" in the market if we make #healthcare too accessible. Reality or Myth? Kristi Henderson (@kristihenderson) Myth! Havent seen it yet implementing #telehealth across the U.S. for multiple systems, across specialties and settings over 17 years. What is a fact, however, is that if we do not change our healthcare system, we will see continued increased cost and poor outcomes. #telemednow Jamey Edwards (@jameyedwards) Bam. Can't argue with that. Access leads to earlier consumption at lower acuity levels, better overall health and fewer acute instances. I think we have a few other folks we need to convince on this who focus on cost instead of value. #supplychain

Q3 What are some creative models #payors are implementing with #telehealth? A3 Notable Responses: Evan Kirstel (@EvanKirstel) A provider w/ a network of primary care physicians can offer #telemedicine care to the workforce of an employer through a combination of an on-site kiosk and an app Ritu Thamman (@iamritu) nyti.ms/2YyAgQo largest insurers, like @Anthem & @UHC had 2nd-quarter profits so large, will have to pay back some to consumers & they could fund studies showing non-inferiority of #TelemedNow compared to in-person care;need to look at outcomes & patient satisfaction Andrew Watson (@arwmd) Virtual first benefits makes so much sense. The platforms are in place to support this, uncertainty with Covid there is consumer demand. #TelemedNow THE hard part here is tying this to primary care in a meaningful fashion. It’s always been a challenge for #Telemedicine. Michael Bagel (@MichaelBagel) @arwmd, how do we use #telehealth to make meaningful progress to reinvent primary care? Seems like PCPs are some of the best equipped to deliver #virtualcare and develop relationships with patients. Always excited to discuss with @hwangc01 and @_ACHP members! #TelemedNow Kristi Henderson (@KristiHenderson) Im seeing the biggest interest in creative models for maternity/women's health, virtual primary care and specific behavioral health needs like SUD. Helen Burstin (@HelenBurstin) Very strong interest in SUD and chronic pain. @theNAMedicine Opioid Collaborative has new #telehealth task force. We need reg support for virtual SUD #TMAT treatment and remote pain management beyond the pandemic Salim Saiyed (@SalimCMIO) we had #medicaid plans prior to #covid19 that would reimburse the same as in person. Definitely payor out there that are ready to take bold steps to innovate on #TelemedNow Ambrazure (@ambrazure) so creative! accelerate their journey 2 the grave! Just saw this woman last week. Since March nobody would see her in person 4 her "pain with swallowing". She had many a telemed visit. Omeprazole, carafate... Guess what stage her #lungcancer is now? (But she is #safe from #Covid) Judd Hollander (@JuddHollander) One of the coolest things we did @TJUHospital was to waive ER and UC co-pays if our employees called JeffConnect first. They got ER doc on telehealth to advise. We reduced ER visits, saved a ton of money and most of the patients who went to ER got admitted or procedure. SNedzaMD (@PoetsEco) Great for integrated systems with employed docs but not great for those practicing in community where survival depends on ED volume. Many residents want independent practice that will become increasingly impossible. How do we fix this? Aditi Joshi (@draditijoshi) Revamp our entire payment model. Ok but realistically is conversion to value based care instead of RVU based EDs #telemednow Jim St. Clair (@jstclair1) Aditi, I think realistically IS revamp our entire payment model. Even value based care has economic limits. The current system IMO can't be "tweaked" to support ground-up, #virtualcare DPC-like billing model #telemednow Aditi Joshi (@draditijoshi) Oooh you all heard it here first from @jstclair1! Who else is in to recreate it all? Q4 What are the challenges for #payors in terms of implementing #Telemedicine? A4 Notable Responses: Andrew Watson (@arwmd) It’s a great question, and I think integrating into hospital operations and outpatient clinic operations are high on the list, along with interoperability. #TelemedNow also, integrating into benefit systems for eligibility is key. Ginny Whitman (@GinWhitman) interoperability...its (needed) everywhere Salim Saiyed (@SalimCMIO) interoperability is key along with #bigdata to make sense of #telemednow outcomes Ceci Connolly (@CeciConnolly) We hear concerns that providers/hospitals are strongly encouraging patients to return to in-person care when #telehealth may be a safer option during #COVID19 outbreak. Ritu Thamman (@iamritu) Access is (key) bridge the urban-rural digital divide & care of older/underserved w/o smartphones or tools like cognition, broadband, data plans,culturally acceptable, & no language barriers Also no RCT data or proven cost effectiveness https://bit.ly/31wpTP5 Chad Ellimoottil (@chadellimoottil) One big challenge payors will face is determining when telehealth is being overused. For example, if telehealth adoption leads to more frequent doctor visits, is that a good thing or a bad thing? Stacy Hurt (@stacy_hurt) As a patient advocate, more doctor visits is never a bad thing- especially for screenings, which we have to get back up to pre-COVID levels- if #telehealth can somehow help with that and save a life, then it is worth it! #coloncancer #survivor #colonoscopy #TelemedNow Kristi Henderson (@KristiHenderson) My favorite statement of the day @iamritu "Platform syndrome: The condition of building platforms as the default for every problem in #digitalhealth" #Telemednow Aditi Joshi (@draditijoshi) RAND study we all saw did show overutiization of services. However there is a cost benefit to increasing access that early adoption couldnt predict. what happens with broad expansion/access? predicting costly future use is difficult but that’s public health... Rasu Shrestha (@RasuShrestha) Reality is, while #telemedicine is the "secret weapon" for payors, it's most effective when implemented with providers. The magic happens when payors and provoders work TOGETHER around their patient/member. Salim Saiyed (@SalimCMIO) also how to integrate into #patient home for safe care. lot of #hospital at home models happening, but limited reimbursement pre #covid We need same for #rpm #telemednow Judd Hollander (@JuddHollander) Easy to increase utilization when you offer access to people with crappy access before. Secret is to integrate telemedicine into access so patients and providers can optimize efficiency. #telemednow Ginny Whitman (@GinWhitman) Such a fantastic point! #TelemedNow fills in the gaps of what patients were previously lacking Salim Saiyed (@SalimCMIO) √ outcomes data √ having guardrails for #telemednow use √ how to create quality metrics , incentivize appropriate use Chad Ellimoottil (@chadellimoottil) In one of our studies (under review), we saw a small increase in more downstream utilization (ER, urgent care, office) when visits for upper respiratory infection were initiated by telemed vs PCP. I agree @draditijoshi, difficult to predict what will happen with broad adoption. Aditi Joshi (draditijoshi) @chadellimoottil look forward to reading your study. Do yo have an insight as to whether it was provide/patient new to practicing telehealth and higher referral rate. We have found it decreases with QA and experience (no shock there) #telemednow Ceci Connolly (@CeciConnolly) We hear concerns that providers/hospitals are strongly encouraging patients to return to in-person care when #telehealth may be a safer option during #COVID19 outbreak. Q5 What are the benefits to #payors of #Telemedicine? How do payors (what metrics) measure success? A5 Notable Responses: Ritu Thamman (@iamritu) -less hospitalizations, better clinical parameters(glucose/BP or med adherence) -˄ $ biz model where device company pays for device + data plan, revenue sharing w health system for Pro-Fee & billing which ˅ inequity & ˄ patient access #telemednow Matt Sakumoto (@MattSakumoto) Telemed Success Metrics should all be based on QuadAim. ED/Hosp utilization (cost), % preventative care addressed (quality), Pt-Prov Satisfaction. #TelemedNow Andrew Watson (@arwmd) Value. Esp though #HEDIS @PeggyNCQA @NCQA who will be joining our chat 9/16 Judd Hollander (@JuddHollander) comment. The largest benefit is .....drum roll please.... it does not cost them anything because the patients get care without them paying for it. Judd Hollander (@JuddHollander) I find it disconcerting that some payers will cover telemedicine with national provider networks but not with in network physicians who already care for the patient. There should be laws against that. Talk about care coordination ...but actually prevent it. Sad #telemednow Stev Sonnier (@StevlandS) A main benefit for #payors is the opportunity to provide #preventive care for those who need it the most. In our issue brief, we provide ways to that #payors can support #telehealthnow for #older, #rural, #mulitcultural, and less #connected patients. https://impaqint.com/work/issue-briefs/expansion-telehealth-equity-considerations-policymakers-providers-payers Aditi Joshi (@draditijoshi) same way we measure success for in person care - efficiency, quality, allowing appropriate care and rate of referral. Patients directed to right next step and health goals and outcomes. #telemednow Helen Burstin (@HelenBurstin) I worry about different metrics for #telehealth success for payors, systems, clinicians, and patients. We need to build shared model for success, based on improved access, quality, outcomes, costs, as well as patient and clinician experience #TelemedNow Rasu Shrestha (@RasuShrestha) Ultimate success factor = health. The goal is to thrive, vs merely survive.

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