Virtual care provides a modern way to solve some challenges payers face, including how to improve member care and manage rising healthcare costs. Remote monitoring services and other virtual care technologies provide tools that enable payers to enhance the quality of and access to care while minimizing costs simultaneously. The benefits of virtual care to payers can also be of benefit to members.

How Virtual Care Expansion Impacts Payers

The expansion of virtual care is what allows insurers and, therefore, their members to gain these benefits. The coronavirus pandemic spurred the growth of these virtual services. They gave people a way to continue to see clinicians while following stay-at-home orders and reducing exposure to COVID-19.

During the pandemic, virtual care especially allowed patients to continue with their regular medical care while they may have otherwise avoided their care due to quarantine, and closed or limited medical services. These needs supported the expansion of virtual care, which was already in place and growing prior to the pandemic.

In addition, the pandemic helped virtual care become more broadly accepted and adopted by everyone from payers and providers to members themselves. Another factor created by the pandemic was looser regulations on the federal and state levels that facilitated the broadening of virtual care. These will mostly stay in place to retain and continue the work that was started. Now, consumer demand continues to push telehealth forward, as patients have become more accustomed to this healthcare option and have come to expect it.

Changes in society and the medical field have now made it easier for payers to start and expand virtual care and remote patient monitoring services. It is worthwhile for insurers to expand their virtual care offerings to continue to meet the needs of their members going forward. Virtual care facilitates higher quality care, better access to care and continuous care, which can all support the benefit of improving member satisfaction. At the same time, virtual care helps to reduce costs. These are all important benefits of telehealth for both payers and members.

Challenges and Benefits of Telehealth for Payers

The widespread expansion of telehealth makes it easier for insurers to tackle the challenges of adopting virtual care to provide its benefits to members.

Challenges and solutions:

  • A switch to value-based from fee-for-service care: Virtual care, including Remote Patient Monitoring services, helps provide better value and facilitates patient-centered care.
  • Settings that still use a fee-for-service model: Providers in these settings may not be properly compensated for virtual care services, yet shifting to a value-based care model provides a solution that integrates virtual care services while providing better care altogether.
  • Technology gaps: Not all providers will have the technology, which may require payer investments to solve this challenge.
  • Providing quality care to all members: Virtual care allows providers and payers to keep up with the needs of everyone, from low to high risk.
  • Managing rising costs of care: Virtual care helps reduce costs through steps like preventing unnecessary visits, minimizing hospital readmissions, increasing access to care to better manage problems, reserving in-person visits for complex cases, and providing preventive care.
  • Meeting consumer demand and varying preferences: Expanded virtual care offerings provide members with options for receiving care.
  • Missed appointments: More patient engagement through virtual care can help reduce rates of no-shows and cancellations.
  • Providers may find virtual payments challenging: Payers can help with payment coverage policies that enable easier usage of virtual technologies by providers and members.
  • Security concerns: Policy interventions can help create a balance between security and access.

Remote Patient Monitoring (RPM) services offer certain benefits. For example, RPM can help payers understand each member’s health care utilization. This facilitates sharing information with members, providing specific recommendations to them and best managing their care. It especially makes it easier for payers to provide preventive care and ongoing care for chronic conditions, which helps improve health, reduce further health problems and cut costs.

Some of the many services a insurer can provide its members include:

  • Varying ways to receive non-urgent care, such as chat, video, email, secure text, apps and/or video
    Direct provider-to-patient support
  • Virtual educational and support programs, such as diabetes and peer group programs
  • Remote Patient Monitoring services
  • As-needed care and ongoing care for chronic conditions
  • A balance of in-person and virtual care
  • Technology combined with the human touch of care management, case management, triage care, telecare management, and similar services

Advantages of AMC Health’s RPM Program

AMC Health offers remote patient monitoring services and telecare management that helps rightly combine technology and a human touch for improved care. Payers can gain specific advantages through AMC Health's services.

AMC Health's Virtual Care Benefits:

  • Increased access to care
  • Better HEDIS/STARS quality
  • Data for identifying clinical and non-clinical risk factors
  • Support in identifying social determinants to health barriers 
  • Reduced readmissions and avoidable hospitalizations 
  • Better member engagement in self-care 
  • Improved member satisfaction
  • Lower total cost of care/MLR

Overall, payers can gain direct benefits of virtual care and remote patient monitoring that can also benefit their members, improve the user experience, care, and reduce costs. Explore how AMC Health helps payers support the member experience through telehealth services.

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