Telehealth clearly saw a COVID-19-related acceleration in adoption. Part necessity and part tool to address access issues, telehealth has had an impact in the short term. What happens in the long term is still an open question. Access to healthcare is one more concern that has come to the fore during the pandemic. While COVID-19 strikes without regard to status, appropriate healthcare has been uneven. Long-experienced disparities have come into the national spotlight. Today as before, the lack of care is not for lack of caring. The problem is lack of access. An existing solution could be ramped up to care for those who’ve been on the sidelines; telehealth could be the remedy that provides access and equity.
Barriers to overcome
The healthcare needs of large swaths of the nation have been and are unmet. Barriers include rural settings with few or no nearby facilities, language limitations, mobility constraints, medical and social vulnerabilities, and restricted income and insurance coverage. Many of these challenges are mirrored in the internet and computer divide required for telehealth and are present in many of these same demographic sectors. Telehealth can play a critical role in increasing access for patient populations, but only after it overcomes governmental, societal and organizational hurdles of its own.
"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."
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."
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.
- 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."
- Analyze telehealth utilization data to identify potential access gaps.
- 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
“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.’”
National Managing Principal, Healthcare
+1 404 475 0180
Director, Public Policy
+1 703 637 3065
+1 212 542 9616
Managing Director, Finance and Revenue Cycle
+1 312 602 8916
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