Virtual care solutions can solve some challenges payers face by improving member care, managing rising healthcare costs, improving Centers for Medicare and Medicaid Services Star Ratings, increasing member engagement, and reducing hospital readmissions.
Digital health solutions provide tools that enable payers to address concerns such as social determinants of health (SDOH) by improving access to care while minimizing costs. The benefits of these solutions extend beyond payers, however. Members also experience the benefits of virtual care solutions.
How Virtual Care Expansion Impacts Payers
During the pandemic, virtual care allowed patients to continue with their regular medical care, which they may have otherwise avoided or delayed because of quarantine or closed or limited medical services.
In addition, the pandemic helped virtual care become more broadly accepted and adopted by everyone, from payers and providers to members themselves. Today, virtual care solutions can help improve Star Ratings and offer significant benefits beyond regular medical services. They’re also essential for managing chronic conditions, reducing hospital readmissions, cutting costs, improving member health outcomes, and providing continuity of care.
Continuity of care is important for anyone with a health condition, but it’s especially important for those with chronic conditions, and it enables care teams to focus on person-centered care. For example, hypertension is one of the most common chronic conditions, and only 1 in 4 adults have control of their hypertension. This has a large impact on payers and members because chronic conditions are expensive to treat and can often lead to hospitalization.
Virtual care solutions provide personalized support and interventions that are highly beneficial to improving quality of life and reducing hospital readmissions. According to our study on the impact of virtual care solutions compared to a usual care group, those in the virtual care intervention group had better blood pressure during the 12-month study period, which continued throughout the follow-up study period.
Virtual care solutions also help bridge the gap between underserved and vulnerable populations and their care teams, promoting health equity. These solutions further address gaps by providing SDOH assessments, surveys, and advanced analytics to identify member-specific risks and then develop customized care plans.
Benefits of Virtual Care Solutions for Payers
The widespread expansion of virtual care makes it easier for insurers to tackle the challenges of adopting virtual care to provide its benefits to members.
Virtual care solutions allow payers to:
Offer patient-centered care.
Virtual care helps provide better value and facilitates patient-centered care. Members have access to their care team from their homes, enabling them to receive care when needed instead of delaying. Additionally, virtual care boosts member engagement, which can help reduce rates of no-shows and cancellations.
Shift from fee-for-service care.
Providers in settings that still use a fee-for-service model may not be properly compensated for virtual care services. Shifting to a value-based care model provides a solution that integrates virtual care services while providing better care altogether.
Solve technology gaps.
Not all providers will have the technology, which may require payer investments to solve this challenge. However, when providers engage in virtual care solutions, there’s a 3.3 times return on investment. Additionally, the value these solutions provide can outweigh the initial investment.
Provide quality care to all members.
Virtual care allows providers and payers to keep up with the needs of everyone, from low- to high-risk members. Additionally, advanced analytics can help identify specific risks, which can be used to customize a care plan.
Manage rising costs of care.
Virtual care helps reduce costs through steps such as 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.
Evaluate members’ health care utilization.
Digital health solutions can help payers understand each member’s health care utilization. This facilitates the sharing of information with members to provide specific recommendations and help to best manage 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.
Build trust.
It can also help build trust between members and their care teams. According to research, 36 percent of health plan members stated that their health plan “always” or “most of the time” acts in their best interest, while 25 percent of members view their health plan as a trusted partner.
Some of the many services a health plan can provide its members include:
- Varying ways to receive nonurgent 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
- Virtual care solutions
- 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, connected care, and similar services
Advantages of AMC Health’s Digital Health Program
AMC Health offers more than data. We’re your partner in connected care. Our connected care solutions drive real-time insights that enhance your financial results, clinical team efficiency, and member experiences.
Our solution drives quality care with digital health solutions, enables teams to improve outcomes with clinical decision technology, empowers staff members to deliver personalized care to members, and integrates advanced technology that builds the care experiences members deserve.
Our results include:
- 97 percent patient satisfaction
- 45 percent reduction in emergency department visits
- 75 percent reduction in readmissions
- 10 times return on investment
See how these results transfer to the management of chronic conditions in our case study on the impact of digital care management on members with hypertension.
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