Proving Value with Data

What matters to Payors and Legislators

Healthcare using a wide variety of modalities has been provided to Americans for several decades, started by the military and Veteran’s Administration. For the most part, few providers were reimbursed for care provided using these modalities until COVID-19 in early 2020. Since then, physicians, as well as other provider types have been reimbursed for care by video, telephone, and remote monitoring. How should reimbursement be continued post-pandemic? How should this be decided?

The following care modalities are included under the telehealth umbrella below:  

• Video, synchronous, asynchronous  
• Telephone  
• Email, including, but not limited to, store and forward photos/videos  
• Text/Chat  
• Remote Patient Monitoring  
• Artificial Intelligence/algorithm-driven care

Reimbursement should be driven by the achievement of specific goals including, but not limited to: 

1. Reduced cost of care, to the US healthcare system and/or to the patient, without reduction in clinical outcomes
2.  Improved clinical outcomes, without increased cost, to the US healthcare system and/or patient, which may be related to improved access

Challenge  

• What are the key data points and outcomes to inform stakeholders making reimbursement decisions (payors and legislators), for appropriate reimbursement to achieve the goals above? What, specifically, should be measured, optimally standardized across provider organizations? How high or low should the goals be set? For which specialties and diagnoses are these questions most important?  
• This will include finding, collecting, analyzing and standardizing data available.

Audience

 Payors, legislators and regulators, clinicians, and healthcare administrators 

Work Stream Leaders 

Jan Ground PT, MBA, led innovation and virtual care at Kaiser Permanente Colorado, where she worked for 18 years. Jan leads several American Telemedicine Association (ATA) Special Interest Group sub committees. Ms. Ground’s expertise is in leading change, a significant need in implementing virtual care, and in working with leaders to clearly define a measurable problem before implementing a new approach to care. Her greatest passion is working with healthcare leaders to lower the cost of the American healthcare system without lowering clinical outcomes and to improving clinical outcomes without increasing the cost.

Jonathan Marenus JD, is General Counsel at Telecare Anywhere, a telehealth-based startup that provides care for injured workers in Workers’ Compensation cases. His work focuses on  regulatory compliance for startups at present and Fortune 500 companies before that. In his time working within the healthcare industry, Jonathan has come to believe that access to healthcare through telehealth modalities is essential to progressing the American healthcare system into the future and that expanding that access will lead to improving the quality of life of many Americans across the country.

Join 

Register to join the initiative and stay abreast. Email info@partnersindigitalhealth.com with the subject line: Proving the Value of Telehealth with Data.