Incorporating modern technology benefits into Medicare Advantage plans

Kishlay Anand, MD, MS

Dr. Kishlay Anand is a board-certified cardiologist and electrophysiologist and Akos CEO and co-founder. Dr. Anand garnered extensive administrative experience serving as Chairman of InstantMed Health Center, an innovative healthcare delivery model with Urgent Care and Primary Care Centers in the Phoenix metropolitan area providing lab, radiology, and diagnostics—all at one convenient location. 

Proactive virtual care is easing the clinical burden of Emergency Department reactive services.

With the explosion of COVID-19, Medicare Advantage (MA) plans began to broadly adopt telemedicine benefits for the first time in 2020. The Center for Medicare and Medicaid Services (CMS) approved the use of telemedicine for the treatment of COVID-19 in March, then expanded the benefit permanently soon thereafter. Most recently, CMS introduced the Acute Hospital Care at Home program, which allows for daily patient monitoring by treating acute care patients from home. 

In addition to telemedicine, CMS added 135 additional services to MA plans in 2020, including inpatient and nursing facility visits, discharge day management services and visits to the emergency room. Although these benefits are valuable, technology and at-home care benefits can’t be overlooked during a global health crisis. As higher-risk patients need to find virtual ways to access their providers, MA plans must cover telemedicine, telehealth, and other at-home care solutions.

Telehealth should no longer be optional

Telehealth is bridging the care gap for both high-acuity patients and patients who would otherwise avoid their healthcare visits. When patients can quickly access their health records, providers or care teams from home, clinics are more equipped to monitor patient’s symptoms that could be of concern. This proactive care can also help to unveil larger, underlying conditions that can threaten patient health.

Telemedicine also tends to be more cost-effective for payers. Even though the cost of virtual care is similar to the cost of in-person care for most MA members, it helps reduce overall healthcare expenses by eliminating unnecessary hospital visits. When concerned patients can virtually connect with their providers safely from home, their providers can tell them whether they need to visit the Emergency Department or if non-emergent treatments are sufficient.

Additionally, The U.S. Department of Health Services reported that nearly half of all Medicare primary care visits were through telemedicine in April alone; this form of care isn’t going to subside in popularity once the COVID-19 crisis eases. As Medicare-eligible seniors become more technologically literate, virtual care will continue to grow in popularity and importance.

The case for Remote Patient Monitoring

Telemedicine coverage through most MA plans is rising substantially, but Remote Patient Monitoring (RPM) should be equally prioritized. Fortunately, CMS just took a major step in the promotion of RPM. On December 1, 2020, CMS finalized its RPM regulations for 2021, which includes guidelines on medical devices for remote monitoring, a revised definition of direct supervision during COVID-19, and clarification on its payment policies.

RPM is critical for high risk patients. Although MA plans are covering RPM and the majority of plan providers are waiving patient responsibility, most MA plans aren’t providing the devices such as glucometers, pulse-oximeters, blood pressure cuffs, wearable devices, and corresponding web-based solutions. Although that could change in the upcoming years, patients in need of consistent care should have access to remote monitoring.

Making technology accessible for everyone

As virtual care continues to gain traction, MA providers need to have a plan to ensure members can access their health services without issue. This can include sending step-by-step instructions on how to enter their virtual appointment, providing a cellular hotspot to transmit data without patient interaction, or by having a team of care navigators who are qualified to assist.

Care navigators can be a critical component for patients who need help understanding the complexities of the healthcare system. Navigators are a great resource to assist with tasks like arranging transportation to in-person appointments, helping patients refill their prescriptions or organizing drug delivery services. They serve as advocates throughout a patient’s healthcare journey and significantly improve accessibility for patients who might otherwise struggle to connect to their healthcare providers. 

Technology is now at the disposal of the healthcare community to elevate patient care, improve health outcomes, and increase access to quality medical services. For this reason, telehealth and telemedicine will continue to grow in importance as access and ease-of-use for medical technology increases. Proactive virtual care is easing the clinical care burden of in-person, Emergency Department reactive care. This level of simplicity is paramount, especially during the COVID-19 pandemic.

About the Author

Dr. Kishlay Anand is a board-certified cardiologist and electrophysiologist and Akos CEO and co-founder. Dr. Anand garnered extensive administrative experience serving as Chairman of InstantMed Health Center, an innovative healthcare delivery model with Urgent Care and Primary Care Centers in the Phoenix metropolitan area providing lab, radiology, and diagnostics—all at one convenient location.