Driving New Delivery Model Strategies

Right now, health providers large and small are experiencing a renaissance in how they can effectively provide personal, quality care to patients through technology. The innovation and acceptance that resulted from the healthcare industry adapting to the COVD-19 pandemic have proven that the new delivery models for care are here to stay. With less stringent regulations on healthcare delivery models and changes to reimbursement policies, concepts like telehealth and acute care hospital at home have quickly been developed and improved.

And because these innovations have been embraced both by providers and patients, now is the time to design your strategy to capitalize on that momentum and prepare your organization to serve your patients with the care in a way that they have come to expect.

Telehealth is a Great Call

2019 was not that long ago, but at the time telehealth options attracted less than 11 percent of consumers. 77 percent of physicians were also leery, citing reimbursement as a barrier to utilizing the technology. But weeks into the pandemic, telehealth became a valuable tool and Waiver 1135 of traditional Medicare fee-for-service guidance paved the way for expanded adoption. Just some of the issues Waiver 1135 addressed included:

• Expanding location – now providers can deliver care from a healthcare setting to patients in all areas of the country instead of just their market
• Expanded patient categories – now providers can care for new patients instead of only existing patients
• Expanded list of services – providers are able to deliver a larger selection of services and testing via telehealth

From these changes, telehealth quickly evolved and produced positive benefits for providers and patients. By being able to treat patients in their homes, physicians were able to prioritize the safety of their patients (reducing the risk of falls and anxiety over getting to the appointment) and protecting medical staff from exposure to COVID-19 and other viruses. Telehealth also reduced the cost and waste of resources from no-shows and cancellations.

Public health systems have strengthened and there has been an improvement in health equity because of expanding telehealth which now allows healthcare providers to reach populations that have been long underserved or struggled with access to care. People living in rural areas, patients lacking reliable transportation or the ability to take time off work, and those with medical conditions that made it difficult to leave the house can now get care when and how it's most convenient for them.

In addition, telehealth has changed the competitive landscape for private healthcare, giving providers opportunities to provide cost-effective, convenient care to an increased number of patients. This introduces new revenue streams while allowing providers to save money, address resource shortages, and maintain a competitive edge in an increasingly consumer-driven healthcare market.

Equally important, telehealth engaged patients in their own care. The innovative healthcare delivery model mirrors the service experience they have with online retailers and streaming services. Consequently, most of the patients are tech-savvy enough to utilize the tools and for those that need technical support, Medicare and other insurers will pay providers' non-clinical staff to support technical connectivity. The result is that physicians now have an effective, private, comfortable method to consult with patients and manage their progress — through an experience that patients have come to expect.

Tech Evolution = Care Opportunities

Technology continues to advance. Increasingly, the Food and Drug Administration (FDA) is giving smart devices and fitness wearables clearance to monitor and share patient information.

Can your care model integrate these advancements?

1. https://techthelead.com/apple-healthcare-powered-by-apple-watch-is-this-the-future/
2. https://www.darkdaily.com/2020/11/25/fitbit-receives-fda-approval-for-a-wearable-device-app-that-detects-atrial-fibrillation/
3. https://www.cnbc.com/2021/08/05/amazon-invested-millions-in-nautilus-biotechnology.html

Acute Care Hospital at Home

Another result of the regulatory waivers is the utilization of Acute Care Hospital at Home. When healthcare facilities were filled with COVID-19 patients, providers innovated methods for serving 151 MS-DRG patients in their home setting. This model allows for a provider to evaluate a patient and either move them to an observational unit in a healthcare facility or home.

Some of the most common clinical episodes Acute Care Hospital at Home can address include:

• Pneumonia
• Cellulitis
• CHF
• COPD
• Complex UTI
• Asthma
• Gastroenteritis

This model, however, is not for everyone. Acute Care Hospital at Home requires significant clinical congruence, detailed inclusion and exclusion criteria, as well as the development of clinical pathways (including organizing nursing and clinical staff) and creating a logistics plan for supplies.

Cybersecurity and Delivery Models

As you consider what technology will best facilitate your delivery model growth, you must also develop a cybersecurity plan for your platform to protect your organization and patients. With DHG, you gain a technology and cybersecurity team that can offer guidance on:

• Technology hardware and software
• Network security
• Vendor due diligence
• Patient and provider education
• Risk analysis

Alternative Payment Models

Even with all the interruptions caused by COVID-19, enthusiasm for alternative payment models continued, with many providers leveraging what they learned during the pandemic to inform and accelerate their strategy. In fact, the industry's goal is that, by 2025, 100 percent of Medicare patients will pay through some kind of alternative payment model, so it is important to continue developing a platform. This chart illustrates how providers can plan for a Two-Sided Risk and Population-Based payment model to help drive their care-delivery evolution.

Source: HCP-LAN.ORG

How FORVIS' Healthcare Team Can Help

FORVIS' Healthcare team believes that developing a solid, effective delivery model strategy is a detailed multi-step process and you can look to our professionals to help guide you through each phase.

• Developing your vision – we can help define your opportunities, risks and rewards
• Develop a dynamic financial model – DHG Healthcare professionals will integrate our resources to tailor a financial model for your organization, incorporating metrics for risk, growth, human capital and physician incentives.
• Develop a proof of concept – we will help with your clinical transformation and develop your strategy for aligning providers and standards of care. DHG Healthcare will then test and evaluate your strategy, monitor outcomes and adapt your model accordingly.
• Leverage your proof of concept to advance other payers – DHG Healthcare will utilize your data to drive continued funding and innovation, evolving your financial model with your growth.

We look forward to learning how we can apply our experience, resources and innovation to your success.