Virtual visits are here to stay, but how can medicine measure telehealth’s value to ensure that physicians and other clinicians, patients, payers and society are getting the most possible from the technology?
A new report jointly developed by the AMA and Manatt Health Strategies expands on existing research and offers physicians and others a more robust framework to measure the value of digitally enabled care.
The type of practice and payment arrangement are among five environmental variables in the framework outlined in the report, “Return on Health: Moving Beyond Dollars and Cents in Realizing the Value of Virtual Care.” Clinical outcomes, clinician and patient experience and health equity are included in the six virtual care value-stream measurements.
After explaining each of these environments and measurements, the report offers four real-world examples of how to use the framework to evaluate telehealth and six scenarios to show how the framework can be applied to a new program.
“Understanding the value of virtual care is vital to inform decision making that facilitates the shift to digitally enabled care models that blend the best features of in-person care with those of virtual care,” said AMA Trustee Jack Resneck Jr., MD.
“The AMA’s framework fills a critical need to inclusively define and measure the various benefits generated by virtual care as decision makers design new care models, prioritize investments, and determine appropriate coverage and payment policies in the future," added Dr. Resneck, a San Francisco Bay Area dermatologist and health policy expert.
The Return on Health report also highlights areas of opportunity for payers, policymakers and other industry stakeholders to help overcome challenges that are slowing the evolution to digitally enabled care models. One key step is long-term, fair and equitable payment for the care.
To learn more about the Return on Health initiative and its proposed framework for measuring the value of virtual care, the AMA will offer a webinar May 25, noon CDT, and a virtual panel discussion for you to share experiences starting June 1.
Environmental variables
Based on reviews of existing literature and interviews with more than 20 national experts, the report’s authors identified five environmental variables that will affect the value that any telehealth or virtual health program can generate.
Those variables are:
Type of practice. Whether a practice is an independent, large group, health system or clinic will impact available resources, scalability and breadth of clinical programs.
Payment arrangements. How a clinician gets paid—for example, fee-for-service versus pay-for-performance—will influence a practice’s business priorities and the financial sustainability of virtual care.
Patient population’s social determinants of health. A patient population’s demographics can impact access to, and benefits from, virtual care. Practices also will need to consider this in connectivity requirements, content and other areas that determine how a patient and physician will interact via telehealth.
Clinical use case. Whether a practice is focused on primary, specialty, chronic or acute care will help determine the care model design, data-collection requirements and other areas.
Virtual care modality. Whether it is a video visit, remote patient monitoring or a different patient interaction, the technology requirements, costs, payment potential and operational requirements will be affected.
The AMA telehealth quick guide outlines the first steps to get started and lays out key considerations to implementing telemedicine and explains policy, coding and payment.
Value streams
The six value streams below define the various ways virtual care models can and are generating value. Each is detailed further in the report.
- Clinical outcomes, quality and safety.
- Access to care.
- Patient, family and caregiver experience.
- Clinician experience.
- Financial and operational impact.
- Health equity.
In one of the real-world case studies, Virginia Commonwealth University Health uses the framework to evaluate its telepsychiatry during COVID-19. Patients and clinicians reported satisfaction with the virtual care. And when it came to financial and operational impact, data showed that the no-show rate among psychiatry visits declined to 6% when virtual visits comprised the vast majority of visits. That was down from 11% pre-pandemic.
The AMA’s Telehealth Implementation Playbook walks physicians and practices through a 12-step process to implement real-time audio and visual visits between a clinician and a patient. It is a powerful resource for practices now and as they continue to implement telehealth beyond the pandemic.
