For decades, healthcare reimbursement has been based on volume; the more services provided, the more reimbursement collected. But that era is over.
Uncontrolled healthcare spending has forced lawmakers, stakeholders and federal regulators to search for what they consider to be a better way to deliver and pay for healthcare–and that way is called value-based care. Senior living executives will not be able to avoid this new trend in healthcare and survive financially. It is an all-encompassing system that will require change from all care providers along every part of the healthcare continuum.
Why the Triple Aim Matters to Senior Care
Value-based care was first brought to the forefront in 2007, when Health and Human Services Secretary Donald Berwick, MD, introduced “the Triple Aim.” This Triple Aim –originally to be used for Medicare and Medicaid services–denoted the new emphasis for all of U.S. healthcare. The Triple Aim has infiltrated private payers, and in essence is changing the way America delivers healthcare, and requires:
- An increased consumer-centric focus – as in, healthcare consumers, including seniors, need to take control of their health and be satisfied with the care they are getting;
- An increased emphasis on efficiency, quality and containing costs – much easier said than done. Most senior living homes will tackle this by joining up with other provider networks and groups, sharing the risk for achieving the Triple Aim. They will be rewarded with federal incentives for success in achieving the Triple Aim, and they will lose incentives for failing to do so;
- And, a unified effort to improve the health of the entire population – this is of particular importance to senior care, because seniors are the population with the most chronic conditions.
Telehealth is Key to Value-Based Care
The recently passed Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) is the cornerstone for instituting value-based care, and it includes measures for increasing the use of telehealth.
Particularly, MACRA indicates federal interest in telehealth by mandating federal studies on telehealth care outcomes with Medicare and Medicaid beneficiaries. This is the first important step in persuading lawmakers to reimburse for such care.
Telehealth already has given signs of being able to support value-based care, by making care more convenient and giving healthcare consumers an opportunity to take more of an interest in their own care. Telehealth can cut costs in healthcare by promoting preventative care, which is less costly than waiting for a patient to develop a chronic disease.
Congress is currently working on ways to reimburse for telehealth. On Feb. 3, Sen. Brian Schatz (D-Hawaii) introduced the Creating Opportunities Now for Necessary and Effective Care Technologies (CONNECT) for Health Act, which would expand payment for Medicare telehealth services, improve care outcomes and help cut costs for patients and providers. The bill has strong bipartisan support and 67 organizations behind it, including AARP, American Health Insurance Plans, the American Heart Association, and Kaiser Permanente.
The American Telehealth Association conducted research last year showing that telemedicine saves patients, providers and payers money when compared with traditional approaches to providing care. Some of the findings show savings per patient, per quarter, of approximately 7.7 to 13.3 percent (or $312 to $542).
Chronic diseases and conditions—such as heart disease, stroke, cancer, diabetes, obesity, and arthritis—are among the most common, costly, and preventable of all health problems, according to CDC. And these are the illnesses of the elderly. That’s why preventative care is so critical.
Mobile health and telehealth can be effective in helping to prevent chronic diseases and in helping to lower the cost of maintaining the health of people with these diseases.
Get Ready, Because Value-Based Care Is Here to Stay
With the old fee-for-service physician payment structure gone under MACRA and daily efforts by lawmakers and regulators to rein in healthcare spending, value-based care has sunk its roots deep into the American healthcare system. Wise senior living executives are finding ways to plan for this transition by using telehealth to achieve the Triple Aim. Seniors are benefitting from the use of remote monitoring, telehealth visits with care providers and other forms of telehealth services. Senior living homes are joining with other healthcare providers to form networks of care. These networks are rewarded by the federal government for saving money while improving healthcare outcomes. Telehealth is a key part of this. Now is the time to start planning for the implementation and expansion of telehealth to improve the entire senior population’s health.
How are you preparing for a value-based care reimbursement model through the use of telehealth?