Vanguard Medical Group was one of the more advanced physician groups in the state when it came to telehealth before the COVID-19 pandemic produced a stay-at-home order.
The Fairfield-based group, which has more than 55 doctors and advanced practitioners in 11 offices in North Jersey, used telehealth for some behavioral health services as well as part of a grant program to serve socially isolated elderly patients.
That being said, the services accounted for “maybe 1%” of the group’s revenues in the first month of the year, according to Thomas McCarrick, one of the co-founders of the group who serves as its chief medical officer and chief informatics officer.
That 1% now is proving to be worth a lot.
While many physician groups are struggling to find revenue now that office visits have dropped dramatically under social distancing restrictions, those comfortable with telehealth have been able to take advantage of an opportunity with Horizon Blue Cross Blue Shield of New Jersey.
Newark-based Horizon, the state’s largest insurer by far, was looking to bring more providers into its telehealth network to help handle an unprecedented surge in demand of nearly 300%.
Horizon looked to its value-based partners and those it knew had some experience with telehealth first, hoping to add providers who could treat customers from Horizon’s telemedicine platform — Horizon CareOnline.
This means the doctors were not necessarily dealing with a physician group’s regular patients. In fact, they almost always were not. The doctors were seeing patients who had reached out looking for service through Horizon’s telehealth portal — which provided a new revenue stream.
McCarrick said he was thrilled Vanguard was in position to take advantage of the opportunity — and credited the group’s forays into telehealth as a catalyst.
“We were starting to get comfortable with telemedicine because we had been working in the past year to get our telemedicine platform organized and operational,” McCarrick said. “We were just starting to get it going when, all of a sudden, we were in this crisis. The volume of patients we were seeing had dropped like a rock. So, we were fortuitously well-positioned to be able to flip the switch and have all our providers offering services.”
Allen Karp, Horizon’s executive vice president of health care management and transformation, said the situation is a win-win: Patients get seen faster and providers can recoup some lost revenue.
“We knew we needed to expand our telemedicine capability and capacity,” he said.
The help was urgently needed. Karp said telehealth visits increased from 24,000 to 95,000 for a comparable period in April from a year ago. Because of this, Karp said Horizon took three additional steps that would help both patients and providers access telehealth more easily and efficiently:
- Horizon eliminated all copays for using telehealth: Karp said eliminating an administrative step that usually took place through other personnel in an office setting would enable doctors to concentrate on what they did best: treating patients. Horizon, it should be noted, is not reducing its payout to providers, it is making up the difference.
- Physician groups do not need to use Horizon’s telehealth platform: If groups have a different platform that they are comfortable with, they can continue to use it and be covered, as long as the patient is a Horizon customer. Doing so, however, will prevent groups from picking up additional customers outside of their existing base.
- Physician groups do not have to use a telehealth platform at all: If doctors are more comfortable using Zoom or Facetime — or just having a telephone call —Horizon will cover the visit, provided the patient is a Horizon member.
Karp said the steps were just some of the unprecedented measures the company was taking during unprecedented times.
“We eliminated copays and coinsurance to make it easier,” Karp said. “For the physician, it just made it an easier interaction because they wouldn’t have to try to collect something they may have had no way of collecting. So, we decided to effectively eat that because we want members to get coverage.”
The same goes for covering visits if they are on the platform, on a smart phone or just over the phone.
“Some of our providers — particularly the providers who are still privately owned and on their own — didn’t have the capability for telemedicine,” he said. “When (Centers for Medicare & Medicaid Services) said physicians could communicate by phone, Facetime or Zoom, we agreed to reimburse for that, too.”
Karp said the ability to help physicians who were struggling economically because of what was going on with COVID-19 has been a great bonus.
“There has been a paradigm shift because of the pandemic,” he said. “People were told stay home, so they were not coming into the office. Physicians who had banked on that for their whole career were struggling. They weren’t seeing patients — and, in a fee-for-service system, they weren’t getting paid.”
Some of the adjustments may last only for the duration of the pandemic. It’s a good bet that copays will return at some point in the future and the use of devices that are not on a platform likely will be disallowed for Health Insurance Portability and Accountability Act reasons.
An increased use of telehealth: That’s something both Karp and McCarrick said is here to stay.
“The physicians are much more comfortable with it now,” Karp said. “I’ve gotten feedback from a number of docs who didn’t realize the benefit of telemedicine and telehealth.”
McCarrick said he has seen it, too. He said doctors are realizing the well checkups can just as easily be done through telehealth, which allows them to spend more time with patients who are sick.
And not just more time — more quality time. McCarrick said he saw that firsthand this month.
“We just started doing these, and I had an uncontrolled diabetic that I started working with over video,” he said. “And, while I was trying to get his blood sugar under control, I was also able to get a dietician looped in at the same time. So, telemedicine opened up that opportunity to take better care of this man faster and more efficiently.”
Karp said such treatment will lead to better health — and fewer visits —down the line.
McCarrick said he hopes the growth of telehealth can help solve an immediate problem: The delaying of treatment because of fear of COVID-19.
“There are many people who have a serious chronic illness who are forgoing care because they’re afraid of going to a hospital,” he said. “We’re not only seeing an increased number of deaths, but, also, more people who come to the hospital after they’ve already had their stroke or their heart attack. Then, the opportunity to really help them recover more quickly or save some heart muscle has been lost because of the delay.
“Maybe the silver lining to COVID is that it has really accelerated our use of these technologies and it has forced us to think about basic questions of how do we provide care to patients and what’s the best way to do it. In that respect, this is going to be really healthy for the health care system to have faced these challenges and have had some really important learnings and, hopefully, that’ll lead to better, more accessible care after this crisis is over.”
Increased access, McCarrick said, is making a difference.
“The end goal is really just to take care of the patient — and you have to find any way you can of getting that care for the patient, whether it’s through in-person or via video visits or by texting or by phone. Whatever it is, by hook or by crook, we have to find a way to get to the patient and meet their needs.
“So, I think it’s great that Horizon actually has been quick to recognize that they needed to change this. Dropping the barrier for patients by eliminating the copays and giving us greater flexibility on the video visits and even phone visits has been a huge help. I have some patients who don’t have a smartphone. I can’t do a video visit with them, but they have some important urgent need. Now I can treat them.”