Total cost of care faces new challenges, opportunities

As the COVID-19 pandemic has led to declines in patient volume for routine, wellness-related visits, practices have been faced with challenges in analyzing their total cost of care. In addition, telehealth has added complexity and opportunity for practices as they look for ways to optimize revenue.

On a recent episode of the MGMA Insights podcast, Doral Jacobsen, MBA, FACMPE, CEO, Prosper Beyond, said total cost of care must be approached strategically in the Medicare arena, as practices balance their immediate patient revenues with lifetime costs incurred by patients missing preventative visits.

“I really feel like one of the things we’re going to discover is that stopping care for everybody in every situation, there’s going to be some long-term impact on the healthcare system,” she said. “The trick is getting folks back into the rhythm of preventative care and figuring out the ways to encourage that care to continue.”

On the podcast, Jacobsen noted an exponential rise in Blue Cross Blue Shield telehealth claims from June 2019 to June 2020. If there’s a way for practices to learn to optimize that potential revenue, she said administrators may also be able to bring back furloughed staff or offset losses felt during clinic closures earlier in the year. 

“It’s been really challenging for practices to quickly adopt this [telehealth],” Jacobsen said. “I’ve been just blown away by how rapidly we’ve been able to embrace these platforms and also assist our patients in this transition.”

Jacobsen, an MGMA consultant and author, said communication is key during the pandemic. She has been telling clients to reach out to payer partners and relay what’s happening in their practices.

“At the end of the day, it’s about caring for their members,” she said. “I think it’s OK to have those discussions and conversations with them. We are actively negotiating increased reimbursement for our clients with payers on a daily basis successfully.”

Additional resources:

• MGMA COVID-19 Federal Assistance and Advocacy Center
• MGMA COVID-19 Recovery Center
• MGMA Member Community
• MGMA Consulting
• COVID-19 could cost insurers up to $547B through 2021: report 
• The Paradox of Medical Costs During the Pandemic
• Telehealth Is Here To Stay – Once Payers And Providers Overcome These Hurdles

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MGMA Insights is presented by Decklan McGee, Rob Ketcham and Daniel Williams.

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