Telehealth accelerates toward access and equity

“Helping organizations anticipate how their revenue cycle will be impacted by these telehealth decisions and how to best leverage the technology is something we see a lot of our clients trying to address.”

Adrianne Boylen

Managing Director
Finance and Revenue Cycle
Grant Thornton LLP

For providers, how telehealth impacts physician enterprises is a real consideration. How do Medicare, Medicaid and private insurance continue payment parity post-pandemic? How does telehealth impact the speed of recovery in ambulatory and diagnostic areas? “Helping organizations anticipate how their revenue cycle will be impacted by these telehealth decisions and how to best leverage the technology is something we see a lot of our clients trying to address,” said Adrianne Boylen, managing director in Grant Thornton’s Finance and Revenue Cycle practice.

Encouraging signs from government

“The Biden administration has shown a keen interest in resolving issues of inequality, with a special focus on determinants of health equity,” said David Tyler, Grant Thornton’s Healthcare national managing principal. An example, he said, could be Medicare dollars directed to social services, blending healthcare payments and social interventions. To spur access to Medicaid and Medicare, the administration could use executive branch agency power to reverse restrictions on eligibility and benefits, leading to expanded enrollment. These decisions will have far-reaching impacts in areas like employer-based coverage. If people are pushed into exchange and governmental options, there will be fewer and fewer employer-based health insurance plans. Understanding and being comfortable with that shift will be important.

In his inauguration day executive order, President Biden decreed actions to “pursue a comprehensive approach to advancing equity for all,” naming health as one of three “crises that have exposed and exacerbated inequities.”

In measurements of Medicare fee-for-service providers, expect a greater emphasis on socioeconomic adjustments. Grant Thornton Public Policy Director Jennifer Kerber noted: “We’ll see more analysis of data on health outcomes. The Biden administration wants an evidence-based review of policies. Along with other policies, health equity will have targets to understand what’s working, and what’s not.” If there are resources spent by the government on social interventions, the money has to come from somewhere; providers can expect to face continued downward pressure on rates.

“The Biden administration wants an evidence-based review of policies. Along with other policies, health equity will have targets to understand what’s working, and what’s not.”

Jennifer Kerber

Director
Public Policy
Grant Thornton LLP

This quality-driven approach will put healthcare enterprises in need of sophisticated data analytics capability and, more importantly, make more necessary the corporate ability and resolve to act upon it. For organizations that fall short of quality outcomes as defined by the payors, there will be a more direct link to financial performance. That will place pressure on many provider organizations.

Policy implications related to telehealth, COVID and inequity concerns are examined by the Centers for Disease Control and Prevention (CDC) and the National Center for Biotechnology Information (NCBI). Both the CDC and the NCBI promote support for telehealth as a means to expanding access to healthcare.

Create a telehealth infrastructure to support healthcare equity

At your organization, consider making health equity integral to the implementation and continued development of your telehealth program. Ensure leadership buy-in by through an education about the needs and the increasing expectations, as well the risks in neglecting a commitment to action.

Build an equity focus into your clinical programs. Consider the following in planning strategy and execution. Requirements will increase, but you can stay well ahead of them by making fairness in care your overarching goal.

Strategic approaches

• Invest in population health, quality and standards, and patient experience departments, identifying leaders to drive the efforts — particularly for payors (like a growing percentage of Medicare) that incentivize these efforts.
• Create a governance structure that includes a project management office and a steering committee of cross-function stakeholders.
• Boost community health assessment efforts.
• Adopt technology platforms capable of performing seamless care coordination, real-time evaluation, and immediate delivery of clinical data, referrals and other informational needs.
• Establish partnerships with community-based organizations for purposes such as these:
  
  • Education in using technology
  • Public health collaboration
  • Language assistance
  • Mitigating barriers for people with disabilities

“I think we’ll look back on this period as a confluence of the pandemic and a time in our American society when we said, ’We’ve got to do better, and at the same time do it in a financially responsible way.”

David Tyler

National Managing Principal
Healthcare
Grant Thornton LLP

Tactical action

• Understand the revenue cycle and financial impacts of telehealth.
• Create clearly defined goals for meeting the needs of at-risk patient populations through telehealth and measuring success.
• Assess individual patient access needs — medical, technological, cultural, linguistic — before a telehealth visit.
• Determine communication channels per the needs of the provider and patient:
  
  • Audio-only phone
  • Videoconference

“It’s important to have a view of diversity, equity and inclusion in terms of how we proactively seek opportunities to expand our service to everyone,” Tyler said, “regardless of income level, race or creed. I think we’ll look back on this period as a confluence of the pandemic and a time in our American society when we said, ‘We’ve got to do better, and at the same time do it in a financially responsible way.’”