How to Build Better Relationships with the Health Insurance & Payer Communities

dr Jessica Badichek, Chief Informatics and Compliance Officer, MediTelecare

Modern healthcare is an intricate dance between quality and quantity.

Payers and insurance providers want better outcomes for patients because of the high costs of ill health, while healthcare providers want to ensure their patients are not overlooked and receive appropriate care.

To understand how we can meet the needs of patients and payers, we need to step back and look at the relationship between payer communities and telemedicine services.

Behavioral telemedicine is here to stay

The concept of telemedicine has been around for a while, but it wasn’t until the pandemic that it became the pillar we know today. Before 6 Feet Apart, few insurance companies recognized the importance or necessity of virtual care. Even if the argument seemed convincing, it was too bold. Now, if you were to ask behavioral health professionals how they view providers, they would most likely cite telemedicine as an option.

In other words, telemedicine is here to stay. However, some hurdles need to be cleared to ensure patients receive quality care while reducing medical costs for insurance companies.

An important component of quality healthcare is the balance between quality and quantity. Telemedicine providers need to see a number of patients on a daily basis, but as the number of patients increases, quality measures need to be implemented to ensure each patient receives the best care.

For example, it is sometimes difficult to quantify the impact on behavioral health. However, with quality surgical procedures, you can ensure that each patient receives more comprehensive and comprehensive care that reduces the use of medications such as antipsychotics and benzodiazepines. High-risk psychiatric drugs pose the greatest threat and can lead to more negative outcomes, ultimately leading to higher costs for insurance providers and the paying community.

Is behavioral telemedicine really worth it?

Telemedicine has many benefits; For one, it exponentially lowers costs for patients, families, facilities, and insurance companies. For the patients, it allows them to consult both general and specialized doctors without leaving their homes. Remote treatment by specialists saves gas, time and personnel costs on site and opens up specialized care to patients nationwide.

Telemedicine not only helps reduce costs, but also helps to see more patients, more often. Frequent virtual medical screening reduces the likelihood of patients being hospitalized, which is often costly for insurance providers. In addition, it expands the reach of care through trained providers and can appropriately diagnose behavioral problems and treat individuals with mental illness through a patient-centered approach using clinical protocols.

Older adults and those with behavioral disorders may be more likely to experience mental illness 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 diagnosed with mental illness due to misattributed symptoms and behaviors. These misdiagnoses can lead to inappropriate medication use, such as B. overprescribing high-risk antipsychotics. Regular visits to behaviorally ill patients via telemedicine ensure patients are treated with appropriate and safer medications while increasing the bottom line of any facility.

The healthcare system also suffers from provider and supply shortages, so it’s no wonder more and more digital tools and teletechnology services are being used to increase outreach and serve underserved groups.

So is telemedicine 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 are embracing telemedicine and related practices because they benefit patients by improving access to care, managing misdiagnosis, and reducing insurance costs by preventing further unnecessary health complications.

Normal does not always mean optimal.

In most situations where telemedicine is used, patients visit their clinician/specialist, the clinician creates the clinical notes that trigger a billing code, and the insurer covers the costs. Although efficient, there are still disadvantages. The quality is left solely to the clinician and the clinician. Nothing else ensures patient care.

Telemedicine professionals can often be dispatched to patients with little or no support, leading to costly and sometimes dangerous health consequences. However, steps can be taken to ensure patients receive specialist quality care. The implementation of high quality operational procedures in telemedicine procedures ensures that clinicians are supported and well-equipped to address individual behavioral medicine.

It begins with the manual selection of clinicians during hiring/onboarding and continues through an eligibility process ending with strict internal approval. In order to be able to offer the best possible care, doctors must be supported, trained and offered further training.

With high quality standard operating procedures, insurance providers do not have to worry about the quality of patient care or whether patients are hospitalized due to misdiagnosis or unsafe medication.

Policies and procedures up front and in the middle

How can you implement structures to ensure standardized, high quality and accessible telemedicine services? First, let’s talk about URAC accreditation. URAC is an organization 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 must meet of its own accord.

Payers and insurance providers typically seek partnerships with organizations with URAC accreditation, as this is synonymous with quality care. It represents a differentiator for healthcare and demonstrates the company’s commitment to quality, leading to improved health outcomes for patients. Accreditation also has two financial benefits: increased patient volume leads to increased revenue, and Medicare payments to accredited facilities are sustained due to appropriate patient status placement.

While it is vitally important to have URAC accreditation, facilities can also continually review and implement policies and procedures that ensure practices are within the boundaries of laws and regulations. Procedures strengthen quality standards. For example, behavioral health screening of patients is a common practice that can be used 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 assessments are often an afterthought, but they are a good indicator of how well a patient is adapting to medications, therapies, and other forms of intervention.

Behavior-based telemedicine reduces costs

Although virtual healthcare has grown significantly in recent years, the payer community and insurance providers have yet to realize its full benefits. Utilizing trained providers who can appropriately diagnose and treat behavioral issues through a patient-centered approach using defined clinical protocols results in healthy patients. This ensures patients are treated with appropriate and safe medications and even non-pharmacological options when possible, reducing the risk of adverse outcomes such as hospitalization and medication side effects.

Telemedicine is a great place to start when the payer communities and insurance providers want to work with high patient volumes while applying quality care techniques. Enabling proactive/frequent clinical visits, steps towards URAC accreditation, and implementing quality procedures and policies using telemedicine dramatically reduces the financial burden on payers and insurance providers in the healthcare system.

About dr Jessica Badichek, PharmD, BCGP

dr Badichek received her undergraduate degree from Fairfield University in Connecticut and her doctorate in pharmacy from the University of Sciences in Philadelphia. She is currently Chief Informatics and Compliance Officer at MediTelecare. She has previously worked with patients with opioid use disorders at ComprecareRx Pharmacy (PursueCare) and with hospice and elderly patients at Arrow/Partners Long Term Care Pharmacy. She has extensive experience and knowledge of all aspects of psychopharmacology and the use of psychotropic drugs in geriatric populations.