Telehealth and virtual care services are now widely available in Medicare. While Americans were strongly encouraged to limit face-to-face interactions to prevent the transmission of COVID-19, CMS expanded telehealth availability which allowed more access for patients and providers in both urban and rural areas. As providers began opening their virtual doors, patients across the country - even those unfamiliar with or without easy access to technology - have responded positively to the new opportunities providing access to their healthcare team in virtual settings and CMS has noticed.
Prior to the public health emergency, telehealth services in Medicare were only available in limited circumstances and mostly for patients in rural areas who would be required to travel to local medical facilities. Throughout the COVID-19 pandemic, CMS has conveyed its support for telehealth and has indicated they will continue to support the provision of virtual care beyond the public health emergency without many of the previous, pre-pandemic, restrictions.
To help ensure patients have maximum access to virtual care services during the public health emergency, key changes have been implemented:
- Providers can waive or reduce cost-sharing for telehealth services.
- Providers and patients who use telehealth are not always required to have a previously established relationship.
- Medicare will pay equally for telehealth and face-to-face visits.
- Providers can see both new and established patients for virtual check-ins and e-visits.
- Telehealth and virtual care have been expanded to post-acute care facilities, RHCs and FQHCs.
Given the likelihood of a future that includes the ability to deliver comprehensive virtual care services, increased emphasis is being placed on the success of population health in value-based payment models. Population health addresses a number of concerns for primary care practitioners who are under pressure to deliver more preventive care, offer more chronic care management, with more quality measures.
Today’s physicians routinely experience the increased demands of offering more services, while abiding by more policies and regulations, and trying to make the numbers work. Financial sustainability is the only way providers can maintain operations. However, if they were to provide all the services suggested for a Medicare patient the amount of time spent would be more than the amount of revenue generated. In order to make the numbers work and sustain operations, providers are increasingly turning to population health models where highly skilled nurses work at the top of their license to lead a team-based approach to value-based patient care, which effectively creates more time for physicians. And now, virtual care and telehealth are becoming essential to maintaining a continuity of patient care in this evolving landscape.
At the core of population health is the Annual Wellness Visit (AWV). These comprehensive exams not only reduce total health care costs, but they can also generate up to 6% of revenue per patient. The AWV allows providers to take a comprehensive look at each patient and uncover unmet care needs and implement individual care plans to help them stay healthy and prevent the potential for illness. There are several AWV requirements defined by CMS, which are the minimum elements necessary. Caravan Health offers a successful population health methodology that goes beyond the minimum and engages staff to engage patients to learn more.
Until recently, providers were limited performing the AWV in the office. Physicians are quickly learning that, much like the process of implementing population health workflow changes to improve care and increase revenue, implementing new workflows and adapting the AWV to telehealth is well within their capabilities – and fully allowed by CMS. While some of the preventive screenings will need to be adapted and modifications to workflows will be likely, the AWV, including the AWV with Caravan’s 10 suggested elements, including, but not limited to, a health risk assessment, medication reconciliation, screenings for behavioral health concerns and a personalized prevention plan, can be effectively performed using telehealth which affords providers and their patients more opportunities for care.
Adapting the AWV to telehealth ensures that providers can continue to leverage opportunities to identify patients who would benefit from Chronic Care Management (CCM), which is of particular importance during extreme situations such as a public health emergency. The enrollment of patients into CCM programs helps providers predict patient numbers and likely scenarios. Patients with chronic management needs are typically those who require more services and when not monitored and managed effectively, can result in increased emergency department visits that would otherwise be prevented or deemed unnecessary. The telehealth AWV provides the opportunity to transition more patients to CCM which is a key to improved care delivery.
In addition, patients who are at-risk for depression, anxiety, or other behavioral health illnesses will likely struggle more than patients who have not historically presented to be at-risk during the public health emergency. Behavioral Health Integration (BHI) has already proven to be successful when conducted by trained population health nurses. Quarantine and stay-at-home orders will likely result in increases in behavioral health symptoms and the need for mental health services will likely be intensified. By conducting behavioral health screenings in the telehealth AWV, patients who may feel too depressed or too anxious to otherwise see or speak to their provider, may be more comfortable discussing their concerns virtually from the comfort and privacy of their home surroundings. CMS had already demonstrated its support of BHI in accountable care and with telehealth, providers can use the AWV to screen for behavioral health concerns, including substance use, and initiate interventions or further assessments for their patients.
Keys to successfully adapting the AWV to telehealth include adhering to the new rules released by CMS such as:
Telehealth requires real-time audio and video, where patients and their care
team can see and hear each other. In response to the Public Health Emergency
(PHE), CMS expanded regulations to allow certain telehealth services to be
provided as audio-only visits. The Initial and Subsequent AWV are an allowable
audio-only service during the PHE. Additional services performed with the
AWV may also be allowable. See the CMS guidance on allowable telehealth
and audio-only visits to confirm.
- Requirements for direct supervision must be met including the provision that the provider be immediately available while the patient is with the nurse or staff member.
To provide guidance to successfully adapt the AWV to telehealth, Caravan Health’s ACO experts have created a Quick Start Guide for providers, ‘The Quickstart Guide to Telehealth Annual Wellness Visits’. The Guide includes explanations of telehealth and CMS’ expanded access to telehealth services. Caravan has provided the billing codes that are allowable for AWV telehealth visits and advance care planning and the codes that are not billable. All 10 steps of Caravan’s suggested elements to include in an AWV telehealth visit are provided with a detailed description of how to successfully conduct an AWV using telehealth.
Few providers anticipated that one day conducting AWV’s via telehealth would be acceptable – and billable. Today, health systems and providers everywhere have begun to open their virtual doors to patients who have embraced telehealth opportunities, which allows them to maintain contact with their care teams in safe and healthy ways and provides the foundation for providers to generate sustainable revenue. Virtual care is rapidly becoming a best practice that is likely to here to stay and adapting the AWV to telehealth is a key to that success.
Learn more about Caravan Health’s population health methodology – watch the explainer video below.
Caravan Health is recognized as the nation’s leader in accountable care and has the largest-ever collaborative ACO. Caravan clients consist of more than 25,000 providers, serving nearly 600,000 attributed patient lives, resulting in $46.2M in total shared savings. Caravan clients have continued to report solid performances during the public health emergency by focusing on population health methodologies – including adapting the AWV to telehealth.