How to Build Better Relationships with the Health Insurance & Payer Communities
Modern healthcare is an intricate dance between quality and quantity.
Payers and insurance providers want better patient outcomes due to the high cost of poor health, while health providers want to ensure their patients aren’t overlooked and are appropriately cared for.
To understand how we can satisfy the needs of both patients and payers, we’ll have to take a step back and look at the relationship between payer communities and telehealth services.
Behavioral Telehealth is Here to Stay
The concept of telehealth has been around for a while, but it didn’t become the pillar we know today until the pandemic. Before “6 feet apart”, few insurance companies recognized the importance or necessity of virtual care. So even if the argument seemed compelling, it was too bold. Now, if you were to ask behavioral health individuals how they see providers, they would most likely mention telehealth as an option.
In other words, telehealth is here to stay. However, a few hurdles must be addressed to ensure quality care is provided to patients while cutting medical expenses for insurance companies.
One significant component of quality healthcare includes the balance between quality versus quantity. Telehealth providers need to see a number of patients daily, but with the increasing number of patients, quality measures need to be implemented to ensure that each patient receives the best care.
For example, it is sometimes challenging to quantify behavioral health outcomes. However, with quality operating procedures in place, you can ensure that each patient receives broader, comprehensive care that reduces the use of medications like antipsychotics and benzodiazepines. High-risk psychotropic medications pose the greatest threat and can lead to more negative outcomes, ultimately resulting in higher costs for the insurance provider and payer community.
Is Behavioral Telehealth Really Worth It?
Telehealth has many benefits; for one, it exponentially reduces costs for patients, families, facilities, and insurance companies. For the patients, it allows them to see both general and specialized clinicians without leaving their homes. Seeing specialists remotely cut down on gas, time, and on-site staffing costs and opens patients up to specialized care nationwide.
Not only does Telehealth help cut costs, but it also lends to seeing more patients more frequently. Frequent virtual medical triage significantly reduces the likelihood that patients will be sent to the hospital, which is often costly for insurance providers. In addition, it expands the care reach with trained providers and can appropriately diagnose behavioral issues and treat individuals with mental health conditions through a patient-centered approach using clinical protocols.
Older adults and individuals with behavioral health issues can experience a higher rate of mental health conditions and behaviors, including mood disorders such as Depression or Bipolar Disorder, Anxiety Disorders, Post-traumatic Stress Disorder (PTSD), and Psychotic Disorders. However, these patients are often misdiagnosed with a mental health condition due to misattributed symptoms and behaviors. These misdiagnoses can lead to inappropriate medication use, such as over-prescribing high-risk antipsychotics. Regular visits with behavioral health patients via telehealth ensures patients are treated with appropriate and safer medications while also expanding each facility’s bottom line.
The healthcare system also suffers from provider and care shortages, so it’s no wonder more digital tools and tele-technology services are being leveraged to extend the reach and deliver care to underserved groups.
So, is telehealth worth it? Delivering accessible, patient-centric, high-quality virtual care is the perfect solution for patients, their families, their facility, and their insurance provider. As a result, payers welcome telehealth and related practices as it benefits patients by increasing access to care, managing misdiagnoses, and cutting insurance costs by avoiding further unnecessary health complications.
Normal Doesn’t Always Mean Optimal.
In most situations where telehealth is used, patients visit their clinician/specialist, the clinician writes up the clinical notes that trigger a billing code, and the insurer covers the costs. While efficient, there are still drawbacks. Quality is left up to the clinician and the clinician alone. Nothing else safeguards the patient’s care.
Telehealth clinicians can often be sent to see patients with little to no support, yielding costly and sometimes dangerous health outcomes. However, measures can be taken to ensure patients receive specialized quality care. Implementing quality operating procedures into telehealth practices ensures clinicians are supported and well-equipped to tackle individual behavioral healthcare.
It starts by hand-selecting clinicians during hiring/onboarding and continues through a credentialing process that ends with rigorous internal approval. In order to provide the best care, clinicians need to be supported, trained, and offered continued education.
With quality standard operating procedures, insurance providers don’t need to worry about the quality of each patient’s care or whether the patients will be sent to the hospital due to misdiagnosis or unsafe medication use.
Policies & Procedures Upfront and Center
How can you implement structures to ensure standardized, quality, and accessible telehealth services? First, let’s talk about URAC accreditation. URAC is an organization that is responsible for developing quality standards for the entire healthcare industry. The accreditation process is used to set high standards for a healthcare organization’s systems, procedures, and techniques that the organization has to meet on its own accord.
Payer and insurance providers typically look to partner with organizations with URAC accreditation as it is synonymous with quality care. It provides a mark of distinction for healthcare and demonstrates the company’s commitment to quality, which means improved patient health outcomes. The financial benefits of accreditation are also twofold: Increased patient volume leads to increased revenue, and Medicare payments to accredited facilities are maintained due to appropriate patient status placement.
While it is crucial to have URAC accreditation, facilities can also continually check and implement policies and procedures that ensure practices are within the bounds of laws and regulations. Procedures reinforce quality standards. For example, behavioral health patient screenings are a common practice that can be leveraged to analyze and monitor patients. In addition, telehealth services help care facilities control and monitor patients who often have large amounts of polypharmacy, where a patient may be taking more than one medication.
Screenings and patient analytics are often an afterthought, but they are a good indicator of how well a patient adapts to medications, therapies, and other forms of intervention.
Behavioral Telehealth Cuts Costs
Although virtual healthcare has grown significantly in the last few years, the payer community and insurance providers have yet to harness its advantages fully. Taking advantage of trained providers who can appropriately diagnose and treat behavioral issues through a patient-centered approach using defined clinical protocols lends to healthy patients. This ensures patients are treated with appropriate and safe medications and even non-pharmacologic options when possible, lowering the risk for adverse outcomes such as hospitalizations and medication side effects.
Telehealth is a great place to start if the payer communities and insurance providers seek to work with a high volume of patients while also practicing quality care techniques. Enabling proactive/frequent clinical visits, taking steps towards URAC accreditation, and implementing quality procedures and policies using telehealth drastically reduce the financial burden of payers and insurance providers in the healthcare system.
About Dr. Jessica Badichek, PharmD, BCGP
Dr. Badichek completed her undergraduate studies at Fairfield University in Connecticut and her Doctor of Pharmacy degree at the University of Sciences in Philadelphia. She is currently the Chief Informatics and Compliance Officer at MediTelecare. She has previously worked at ComprecareRx Pharmacy (PursueCare) working with Opioid Use Disorder patients and Arrow/Partners Long Term Care Pharmacy working with hospice and senior patients. She has significant experience and knowledge in all aspects of psycho-pharmacology and the use of psychotropic agents in geriatric populations.