Telehealth flexibilities continue and ACOs are held harmless under public health emergency extension

With the public health emergency extended to April, providers get additional time to use waivers for telehealth and other flexibilities.

Aside from these flexibilities, the public health emergency holds accountable care organizations harmless from financial losses for the months in which the PHE is in effect. For example, if the PHE is in effect for six months in 2021, then ACOs will only be liable for half of the shared losses they may experience this year. 

Also, CMS will remove from ACOs' expenditures COVID-19 episodes. 

Both are important, because caring for COVID-19 patients can be long and expensive, and providers shouldn't worry about patients' spending when managing their care, according to the National Association of ACOs.

Payers also got a break on reporting requirements last year when CMS announced that due to COVID-19 it was suspending data collection and reporting requirements for such quality reporting programs as the Healthcare Effectiveness Data and Information Set (HEDIS).

WHAT TELEHEALTH MEANS FOR INSURERS 

Insurers have seen revisions to quality standards for health plan certification due to the pandemic. Many of these are centered on telehealth.

The nonprofit accrediting organization National Committee for Quality Assurance (NCQA) now recognizes virtual visits as the same as in-person visits. NCQA-certified data is used for HEDIS reporting, which compares health plan performance and is used by over 90% of health plans.

In June, NCQA announced adjustments to 40 HEDIS measures to support the use of video telehealth, telephonic telehealth and e-visits that occur virtually over a portal.

"You cannot drive quality improvement if your measures don't take into account what has quickly become the fastest growing modality for providing healthcare services," NCQA President Margaret E. O'Kane said at the time. 

Yet, in a December blog, NCQA's social media specialist Jazmyne Carter also said this: "Although telehealth has the potential to improve outcomes and access to care for 60 million individuals who live in areas with limited physical access to care, this modality of care can also perpetuate existing issues such as fragmented care, poor care coordination and disparities."

The question has become, what does quality telehealth look like and how can that be standardized?

The deadline for feedback on NCQA's Telehealth Module in Health Plan Accreditation, which proposes integrating telehealth with other care modalities, is Wednesday, January 13. This module will help health plans demonstrate that their telehealth networks provide safe, equitable and coordinated care by credentialed physicians.

MEETING PERFORMANCE TARGETS

Telehealth must not lessen quality scores, said Phil Giarth, director of provider engagement for DataLink Software, which works with healthcare companies to put data in a readable and writable form for electronic health systems. 

EHRs are ready for the data input. But first, payers must get that data lined up. Every payer has a claims detail file, but it will have 30 iterations of the file. There is no one single source of truth, Giarth said. 

The biggest hurdle payers have to overcome is getting the information to a central hub. Health plans should use the breather granted by CMS's temporary suspension of data collection to get their ducks in a row for a solid 2022 date, he said.

"If COVID has taught us one thing, it's that data quality has never been more important," Girth said. "Payers see that and know it is better to get ahead of the curve on data quality than to get behind."

For NCQA and HEDIS, technology is key, Giarth said. COVID-19 exposed disproportionate illness and deaths in underserved communities.

Of the new HEDIS quality measures, 30 to 40 of them affect star-rating measures that impact revenue to the health plan. It's revenue that health plans must use to offer supplemental benefits. But patients must be seen, either in person or through telehealth, to up health plan scores. 

"If I'm not seeing patients," Giarth said, "I'm losing scores." 

THE LARGER TREND

In April, amid a growing COVID-19 pandemic, the Centers for Medicare and Medicaid Services announced the suspension of data collection and reporting linked to several key quality programs, including reporting for the Qualified Health Plan Enrollee Survey, Quality Improvement Strategy and Quality Rating System for plan year 2021.

These previously mandated reporting tools capture key quality indicators of effective health plan preventive strategies, care management and member satisfaction.

Each year, health plans qualifying for the federal exchange must collect clinical data on key performance metrics including HEDIS and Pharmacy Quality Alliance measures.

These insurers must collect clinical data on key performance metrics to ensure they are meeting benchmarks for patient wellness, such as offering colonoscopies and driving medication adherence and safety.

Qualified health plans are usually required to report this information to CMS between May and June. 

Twitter: @SusanJMorse
Email the writer: susan.morse@himssmedia.com