As the healthcare delivery landscape continues to evolve in response to the pandemic, those who are administering and paying for the care have to navigate a complicated and uncertain future. For instance, during the public health emergency (PHE), the Centers of Medicare & Medicaid Services (CMS) added over more than 140 physician fee schedule (PFS) services to the list of services it will pay for when delivered through telehealth. Prior to the emergency, Medicare paid for a limited number of telehealth services and only if they were provided to beneficiaries in a clinician’s office or facility in a rural area.
However, going forward, it’s not yet known what that payment landscape will look like once the PHE ends. Will the changes that CMS put into place expire, with the pre-pandemic payment structure for virtual care going back into place? Or will federal health leaders—including lawmakers in Congress who actually have the power to make payment-focused telehealth changes, rather than CMS and HHS (the Department of Health & Human Services)—listen to the many industry groups who have been calling for the flexibilities granted during the PHE to be made permanent?
To discuss these layered issues further, Healthcare Innovation recently spoke to two leaders in this space—Keith Algozzine, founder and CEO at health technology company UCM Digital Health, whose offerings include a virtual health platform, and Dominick Bizzarro, chief of innovation at Schenectady, N.Y.-based health insurance company MVP Healthcare—about their views on the current moment in telehealth, how they view the future and more. Below are excerpts of that interview.
How does the near-term future look to you in terms of continuing to make investments into telehealth? Do you see it as a worthwhile endeavor to continue to build out and evolve this infrastructure with an unknown telehealth policy and payment landscape?
Algozzine: In our world, we actually don't really think of it as uncertain at all. And we don't look at it from a policy perspective. Policy lags behind innovation, almost everywhere, so our real mindset is how do we provide value for the patient? We find that if you provide value for the patient, there are tons of people who will pay for what we're doing. Value can be defined in lots of different ways—access, quality, predictability, portability, convenience, and satisfaction. There are folks who are more than willing to pay for that value, because ultimately, it is the patient who needs to derive value, and those who are charged with helping the patient in healthcare need to take the lead in this. So, we don't really see it as an uncertain environment. We really see it as a constant press toward providing value to the patient, and honestly, the rest takes care of itself.
Dominick, from the insurer perspective, what are your thoughts around continuing to support virtual health and how that aligns with uncertainty around future funding?
Bizzarro: We also don’t see it as uncertain, but I do understand the basis of your question with respect to uncertainty around the policy. For us, we're fully invested in telemedicine and digital health because we're committed to our members, and we're customer-centric. Even prior to the pandemic, but certainly since the onset of the pandemic, we have felt that people really struggle with timely access to predictable, affordable, and satisfying care. So we're on a path to innovating to solve for that, and innovation is really about creating new value to customers.
In terms of payments, I think the basis of your question might be in fee-for-service payment. But even in that world of fee-for-service payment, if you're completely in that world, and you're looking at it from a predictable, affordable, satisfying, and accessible experience, there is a place for being able to get more immediate access to care to get your questions answered. When you do that with professionals, and the use of technology can get you to the right place and the right setting for care, which may be your kitchen table, that is something that every insurer should be supporting—and certainly we do.
It’s been said that physicians need to know now what telemedicine payments and regulations are going to be look like in a post-pandemic world. What are you hearing on the provider side related to this?
Bizzarro: When the pandemic hit it, the demand for telehealth services increased amongst patients; safe access to care was really important, as was unclogging the ED. As the same time, physician offices basically shut down, and they were instructed to [tell their patients] that these may not be safe environments. But they adapted relatively quickly and there was a relaxation of policies to get that done.
But most of my life has been in healthcare information technology, and a lot of those small practices are serviced by EHR vendors who also adapted to the [new environment], and gave them the means and the technology to be able to connect with patients. In that case, I think it’s up to the individual providers of care to understand how they can best adapt to serve their patients. The pandemic forced all of us to act and adapt, and it was as if you were standing on the shore with the tsunami was coming your way. And you had very limited choices, so you look around and say, what are the choices where we can survive and can continue to provide what we need to the patients who we serve?
As time goes on it will be critical for organizations who have been doing a lot of virtual care delivery to collect really good data about the quality, safety, cost and benefits. How has your organization fared in this area?
Algozzine: Quality is such an ambiguous term. Quality can be in the eye of the beholder. To me, quality is providing the care, but what I think quality is might be different than MVP’s definition of quality, which might be from either a payment or a member standpoint. And of course, ultimately the quality that matters is what the patient defines as quality because they're the end user. So one of the challenges with that question is defining it. It’s like the Albert Einstein quote: if I had 60 minutes to save the world, I would spend the first 55 minutes figuring out the problem and the next five on the solution.
That being said, we have to define it as best we see fit. So we [measure] things such as net promoter scores, patient satisfaction, as well as the number of times times a patient had to be treated via telehealth and needed to go to the ER instead of being taken care of. How many times did they return visit, check back in with us, and have to have a change in treatment? How many times did we follow CDC criteria for antibiotic stewardship versus not [doing so]?
So, there's a lot of complexities in quality. In our experience, at the highest level, we see [quality] as a patient safety [issue], and that we don’t have incidences that put patients at risk. We have tremendously high patient satisfaction in the virtual and digital care that we provide. And the overall outcomes, from a cost perspective, are 5 to 15 times more valuable as far as cost savings when they are done appropriately. So we think we're doing good, but I don't like to overstate it because quality is in the eye of the beholder.
Bizzarro: MVP was asked to participate on a panel recently [as part of the Reimagine New York Commission]. Eric Schmidt’s [former Google CEO and chair of the commission] group was participating, and they released a report pointing to evidence suggesting that telehealth can improve access to care and patient outcomes, as well as increase patient satisfaction and reduce healthcare costs. Cost, access and quality are inextricably linked, because you can't separate them. The easiest path to quality is to make sure that patients have access to the care.
