Health care provider at computer on video call with patient
HealthAugust 09, 2021

Telehealth: Why payers cannot stay on the sidelines

By: Keith Algozzine
The Covid-19 pandemic came suddenly, bringing with it a telehealth boom. While providers have adapted to virtual healthcare, payers also need to embrace a “digital-first” services model, advises Keith Algozzine, founder, and CEO of UCM Digital Health. “If you’re the one who gets the patient through the digital front door, you have much more control over care, from a cost and quality perspective.”

When the pandemic hit, the healthcare industry in general didn’t have the operational infrastructure or resources in place to anticipate the telehealth boom it experienced. Today, however, Algozzine says the industry is working out how to provide telehealth services within sustainable financial models while improving the quality of the patient experience. He envisions a return to 2020’s massive telehealth adoption levels within the next few years.

Transforming the healthcare economy

Algozzine estimates that digital and telehealth services are five to 15 times more efficient than the traditional healthcare system. For example, if a patient injures their ankle, instead of going to the ER and incurring costly, time-consuming treatment, an effective telehealth system would schedule that patient for an x-ray appointment, and from there an orthopedic appointment and all appropriate digital follow-up and scheduling.

“That’s how telehealth can turn care from a series of cumbersome transactions in a fragmented healthcare system to an efficient, frictionless healthcare episode,” he says.

And that, he says, has potential to transform business, not only for payers, but for the entire healthcare economy. McKinsey estimates that $250 billion of current healthcare spend could be virtualized, with 20% of all emergency room visits potentially avoided, and that telehealth solutions deployed for chronic populations can improve total cost of care by 2–3%.

Algozzine thinks even these estimates may be low. “There is much more you can effectively change by creating the correct digital-first and triage systems, which can’t be measured until organizations start to implement them at scale,” he says. “The main barrier to the promise of telehealth is ensuring that healthcare leaders have the vision and courage to inspire their teams to embrace the digital front door.”

It all starts with triage

Technology alone won’t fulfill the profound potential for telehealth to transform American healthcare, says Algozzine. The first step is an efficient triage process.

A sound triage process must seamlessly connect a patient to a qualified healthcare professional — through a virtual visit, or if needed, a live consultation. “If a telehealth system can’t guide a patient through an effective, streamlined triage process,” he warns, “patients will go elsewhere.”

Looking for ways to reduce healthcare costs?

Nearly 8 in 10 clinicians say the expected cost to the patient impacts care decisions — and as costs trend up, these impacts likely will too. Amid growing demand for price transparency, payers and providers need streamlined data and operations to embrace value-based care models.

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Reducing Healthcare Costs

How telehealth can reduce healthcare costs

Effective telehealth systems can generate cost and time savings by avoiding unnecessary visits to physical settings, such as the ER, urgent care, hospitals, and outpatient facilities through staggered levels of service.

Level 1: Evidence-based patient education content

“Providing high-quality, evidence-based content is critical for the consistency and quality of patient education,” Algozzine says, “especially in the payer market, given networks of diverse providers.”

If a patient with a cough accesses a high-quality, digital-first platform, he explains, they might first access its educational content, which might lead the patient to conclude their condition will go away without treatment. “That costs pennies compared to any virtual or physical dialogue with a clinician,” says Algozzine.

Level 2: Asynchronous visit

Communicating with a medical professional by email or text may cost $30–40, Algozzine estimates, as opposed to a live video care visit, which may run roughly $50 to $60.

Level 3: More complex triage

Even complex triage, treatment, and care coordination can be performed outside a hospital, ER or Urgent Care. “All of this is far less costly and more efficient than a visit to a physical healthcare setting,” Algozzine says.

Payers should adopt telehealth as soon as possible, Algozzine advises, because “whoever controls the first step in care often controls the downstream cost and quality.”

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Learn About Digital Health Architect
Keith Algozzine
CEO, UCM Digital Health
Keith Algozzine is CEO of UCM Digital Health, which provides health plans and providers digital health platforms with 24/7 telehealth services. UCM uses the Digital Health Architect solution from Wolters Kluwer, which includes evidence-based content and guidance from UpToDate® and Emmi®, in its virtual health platform.
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