Payors use Telehealth and RPM for Chronic care, complex care, high-risk elderly patients for value-based care

Payors use Telehealth and RPM for Chronic care, complex care, high-risk elderly patients for value-based care

The COVID-19 pandemic has rapidly and unequivocally affected the masses, however the most vulnerable the elderly, chronic care, complex care, comorbidity patient population have suffered the most.

The healthcare industry had to pivot quickly to change the way they deliver care to this patient population. Common issues proliferate, from the very basic dynamics around how care is offered. Providers have had to determine solutions to major issue: “How will the elderly patients access care? Elderly as highly recommended social distancing and that holds them from travelling and even visiting their doctors.

The COVID-19 pandemic caused the health systems to turn to telehealth and remote patient monitoring (RPM). What started as a good to have quickly became a necessity. Many health systems see telehealth as a vital pillar in their care model.

But what about the payers? Are the healthcare payors adopting telehealth as health systems across the country? Have the payers accepted telehealth as an effective model for their large, and many times very diverse, member groups?

In this article, weexplore not only how, but also why, payers are implementing telehealth across their member networks.

Payers Turn to Telehealth & RPM

Across the health systems and other healthcare provider organizations, telehealth and RPM helps elderly patients manage their condition from home. Better managed health means lower utilization, effective use of the healthcare system, lower readmissions, and increased patient satisfaction. These improvements lead into reduced and avoided costs.

Payers, upon seeing these results, have begun to leverage telehealth and RPM to not only understand their members’ health but also to mange it.The different payers have adopted different telehealth modelsas one size fits all approach does not work for the payors. There are common themes across all models, demonstrating how telehealth and RPM has helped payers:

  • Deliver value-based care based on preventative, proactive approaches
  • Engage patient into healthier lifestyles
  • Be proactive with and understand member data
  • Keep members socially connected, well and active at their homes

By keeping their members socially connected, well and active home and better understanding member data, payers can make data-driven decisions, while delivering value-based care.

Payers use Telehealth and RPM to deliver value-based care to their members.

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Preventative Care Move from Reactive to Proactive

Preventative care is the key to health cost reduction. Preventative care moves the care from the reactive episodic care to proactive regular care. RPM, Patient Education, Patient communication, arms providers, and payers with essential tools to provide proactive care remotely and for this reason payers should leverage telehealth and RPM across their member populations – specially the chronically ill, complex care, high-risk geriatric patient populations. Telehealth on tv and RPM provide payers with real-time insight into their members’:

  • Vitals (blood oxygen, blood pressure, glucose, weight, temperature, heart sounds, EKG and more)
  • Medication Management & adherence
  • Symptom Management
  • Patient Regiment Adherence
  • Patient Engagement

With patient data, payers can make informed decisions. By monitoring their members' health, payer’s case management teams can 1) intervene before crises arise; 2) make informed decisions on member escalation measures and, 3) ensure their members are directed to the right care at the right time enabling effective use of the healthcare system reducing resource utilization.

Payers can collaborate with their providers to offer video visitsto their members which provides providers glimpse into the members’ environment, helping the provider and payer incorporate the social determinants of health (SDOH) into the care delivery. SODH, otherwise not found in the medical records, helps the payer understand the environment in which their member lives, resulting in more impactful and custom support to the member.

Seniors use their Television for telehealth and RPM – Using

Keeping Elderly Members Active at Home

Care in the home is the future of healthcare delivery. Elderly patients want to stay and age in their homes. Given their desire to remain out of the hospital these elderly members participate in the telehealth using tv, patient engagement and vitals monitoring programs.

Many payers have identified this trend and have started to create payvider models by partnering with health systems to deliver value based care to their members. One example is Aetna and Landmark Health, who have come together to help Medicare Advantage members manage their chronic conditions at home. To Aetna’s Medicare Advantage members in the NY region, Landmark provides a broad range healthcare delivery services at-home, including acute and urgent care services, health screenings, home safety checks. The goal is to improve quality of care and prevent adverse outcomes, ultimately reducing healthcare costs. When a patient receives care at home, they can avoid the higher cost urgent care sites like Hospital Emergency Department where they may otherwise receive treatment.

Telehealth & RPM for Payers - After the Pandemic:

The pandemic has underscored the importance of providing accessible care, not just during a Public Health Emergency, but always. Members are demanding convenience in how they access their healthcare. Although the younger members can access in the palm of their hand the senior members require other modalities to deliver telehealth and RPM – such as through the Television. Telehealth using tv solves many needs - they make practitioner to patient communication easier and accessible and where they are, improve outcomes, increase patient engagement, and drive down costs. Payers must harness telehealth technology to provide innovative methods of care delivery and member engagement that improves member health and reduces healthcare spending.

In upcoming blogs we’ll discuss Medicare advantage, payment structures, the importance of social determinants of health, primary prevention, and a robust population health strategy. We will also provide ways on how payviders can use telehealth technologies to reduce readmission and reduce ERvisits by their members.

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