Alternative payment methods, such as those utilized in many Accountable Care Organizations (ACOs), are fitting for telehealth services. ACOs view telehealth as a means of increasing revenue by reaching more patients and keeping existing patients out of the hospital, engaging patients through ease of access to providers resulting in greater patient satisfaction, and saving costs by avoiding ER visits and hospital readmissions. (3) Policy advancement, such as NE LB 556, and private sector innovations, like ACOs, are the driving force in making telehealth services available to a broader population.
The passing of NE LB 556 in 2013 harnessed the support and efforts of the University of Nebraska Medical Center in expanding behavioral health teleservices. In addition, the bill amended managed care plans to add reimbursement rates that are comparable to in-person consultations for healthcare services delivered through telehealth technology (8). However, managed care plans are pertinent to only those with Medicaid coverage.
ACOs are the joining of various healthcare stakeholders with a shared goal of meeting the Triple Aim. ACOs believe that the Triple Aim can best be met by veering away from fee-for-service payment models that are driven by volume and procedures and rather, focusing on rewarding outcomes, which stem from quality care and care coordination. (6)
In the early stages of ACOs, the concept was simultaneously trialed by both CMS and private sector entities. Both the public and private sector saw promise in this new concept and have gone on to form many ACOs in each state. (6)
Private sector ACOs, whom are created and run by healthcare providers, hospital systems, physician groups, insurers, and/or community-based organizations, have more flexibility in the core concepts that they wish to employ (i.e. whether or not they want to model their ACO after Medicare’s Shared Savings Program, use bundled payments, pay-for-performance incentives, etc.). (6) The partners in an ACO are equally invested in meeting the Triple Aim goals and thus they are equally at risk if they do not. Having shared risk and cost makes investment in innovative systems like telehealth more attainable.
Quality benchmarking is a common requirement among public and private sector ACOs as an evaluation of the quality of care a provider or healthcare system provides and this equates to the level of reimbursement they receive. (6) Thus telehealth (and it’s reimbursement rate) has become a hot topic throughout these ACOs because of the efficiency of care and great outcomes it has shown to provide.
The benefit (and purpose) of being a part of an ACO is the cost-sharing. Cost-sharing allows small, independently owned clinics to attain the benefits of offering telehealth services without the unreachable price tag that comes along with starting up the program. (4) An example of this is the Midwest Health Coalition ACO, which is made up of more than 900 independent healthcare providers across Nebraska and Iowa (5).
Funding the start-up of telehealth programs may not be the primary barrier for larger organizations. Large organizations are often driven by other factors such as decreasing readmission rates and improving the outcomes of care. These, and other, driving forces led to Nebraska Medicine and Methodist Health Systems to join together forming the Nebraska Health Network, an accountable care alliance. (7)
While there are many other ACOs, I want to mention one last ACO partnership that represents shared risk, responsibility, and reward. The Aetna Whole Health – CHI Health Accountable Care Network is an example of a commercial, product-based ACO that offers business owners/employers in Nebraska and Iowa a healthcare model that creates a savings of up to 15% by improving the health outcomes of their employees. (1) This ACO focuses on creating and utilizing innovative products and services in order to improve the use of healthcare screenings, improve primary care services, and avoid hospitalizations – telehealth is an important tool in meeting these goals.
Private sector innovations are of great importance. While many view CMS as the leader in changing healthcare, they struggle to lead in an avenue that doesn’t have sufficient existing data that proves it’s success. Medicare relies on the private sector for trial and error from which they can then base their models of care on. (2)
- Aetna. (2015). Aetna and CHI health create Nebraska’s first product-based accountable care organization. Retrieved from https://news.aetna.com/news-releases/aetna-and-chi-health-create-nebraskas-first-product-based-accountable-care-organization/
- Evans, M. (2015). Headed for risk: Health systems sign private-sector ACO deals that may lead to capitation. Modern Healthcare. Retrieved from http://www.modernhealthcare.com/article/20150711/MAGAZINE/307119980
- Hyatt, A. (2014). Three ways telehealth drives revenue for ACOs. American Well. Retrieved from https://www.americanwell.com/three-ways-telehealth-drives-revenue-for-acos/
- Lacktman, N. (2015). Telehealth reimbursement under the microscope. Retrieved from http://managedhealthcareexecutive.modernmedicine.com/managed-healthcare-executive/news/telehealth-reimbursement-under-microscope?page=0,1
- Midwest Independent Physicians Practice Association (MIPPA) ACO. (2016). Independent physicians working for you. Retrieved from http://midwestippa.com/aco
- Muhlestein, D. (2013). Continued growth of public and private accountable care organizations. Health Affairs Blog. Retrieved from http://healthaffairs.org/blog/2013/02/19/continued-growth-of-public-and-private-accountable-care-organizations/
- Nebraska Health Network. (n.d.). Nebraska health network: Led by the physicians and health systems of your community. Retrieved from http://www.accountablecarealliance.com/Main/Home.aspx
- Nebraska Legislature. (2013). Legislative bill 556. Retrieved from http://nebraskalegislature.gov/FloorDocs/103/PDF/Slip/LB556.pdf