Total cost of care faces new challenges, opportunities

Podcast - August 11, 2020

Medicare Payment Policies

Reimbursement

Contracting

Andy Stonehouse MA

As the COVID-19 pandemic has led to declines in patient volume for routine, wellness-related visits, practices have been faced with challenges in analyzing their total cost of care. In addition, telehealth has added complexity and opportunity for practices as they look for ways to optimize revenue.

On a recent episode of the MGMA Insights podcast, Doral Jacobsen, MBA, FACMPE, CEO, Prosper Beyond, said total cost of care must be approached strategically in the Medicare arena, as practices balance their immediate patient revenues with lifetime costs incurred by patients missing preventative visits.

“I really feel like one of the things we’re going to discover is that stopping care for everybody in every situation, there’s going to be some long-term impact on the healthcare system,” she said. “The trick is getting folks back into the rhythm of preventative care and figuring out the ways to encourage that care to continue.”

On the podcast, Jacobsen noted an exponential rise in Blue Cross Blue Shield telehealth claims from June 2019 to June 2020. If there’s a way for practices to learn to optimize that potential revenue, she said administrators may also be able to bring back furloughed staff or offset losses felt during clinic closures earlier in the year. 

“It’s been really challenging for practices to quickly adopt this [telehealth],” Jacobsen said. “I’ve been just blown away by how rapidly we’ve been able to embrace these platforms and also assist our patients in this transition.”

Jacobsen, an MGMA consultant and author, said communication is key during the pandemic. She has been telling clients to reach out to payer partners and relay what’s happening in their practices.

“At the end of the day, it’s about caring for their members,” she said. “I think it’s OK to have those discussions and conversations with them. We are actively negotiating increased reimbursement for our clients with payers on a daily basis successfully.”

You can hear more from Jacobsen and other industry experts at MGMA’s virtual Medical Practice Excellence Conference, where she’ll co-present sessions on “Total Cost of Care 2.0: The Quality Payment Program and Beyond” and “RPM and Telehealth: Strategies to Transform Practices to Virtual Health.”

Additional resources:


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MGMA Insights is presented by Decklan McGee, Rob Ketcham and Daniel Williams.

Thanks to Audi for sponsoring this episode. 
  • Click here to learn more about the MGMA Audi Incentive Program.

About the Author

Andy Stonehouse MA
Freelance Writer and Educator Colorado

Andy Stonehouse, MA, is a Colorado-based freelance writer and educator. His professional credits include serving as editor of Employee Benefit News and a variety of financial and insurance publications, in addition to work in the recreation and transportation fields.
 

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