The Public Health Emergency (PHE) is officially ending on May 11. Launched as a desperate measure to support the industry during the pandemic, the PHE ultimately opened our eyes and taught us some valuable lessons about what healthcare could be going forward.
So how did the PHE lay the foundation for a new era of healthcare that integrates virtual care? And when it ends, how can medical organizations seize the future and avoid reverting back to a past that should not be revisited?
Healthcare B.C. (Before COVID)
Let’s face it — the healthcare industry reached a breaking point long before COVID arrived, and there was clear consensus that something had to change.
The economics of healthcare predominantly rewarded organizations for churning through patients, despite progress toward value over volume driven by the Affordable Care Act. And the promise of digital healthcare raised hopes but rarely delivered, with a revolving door of solutions arriving on a wave of hype and fading just as quickly.
Then the world changed. In March 2020, the world shut down, and the healthcare industry scrambled to redefine itself. With physicians’ offices closed and hospitals overflowing with COVID patients, the question was: how do we treat everything else? The answer was obvious: virtual care. The implementation would prove much trickier.
The Good News: Waivers Open the Door to Virtual Care
No matter how good the technology was, virtual care was never going to work under regulations that clearly valued in-person visits more. But COVID left regulators with no choice—make virtual care a financially viable proposition for clinicians, or risk crippling the healthcare industry just when we needed it the most.
Thus began the (official) Public Health Emergency, bringing with it many changes designed to accelerate the digital transition.
The PHE waived many regulatory requirements and limitations, including those governing Medicare. Under these new mandates, virtual care was reimbursed equally to in-person care, and all services were covered. Clinicians could now perform virtual care from anywhere without registering the location. And systems that did not meet privacy or security standards were now permitted.
Through the regulatory changes it necessitated, the pandemic opened a virtual care Pandora’s Box. Patients and clinicians began to see the flexibility and accessibility this new normal might provide. But change driven by desperate need, not strategic vision, is rarely perfect.
The Bad News: Limited Point Solutions Lead to Unwieldy Tech Stacks
Organizations rushed to launch virtual care solutions without the usual vetting—the severity of the situation demanded it. If it solved an urgent problem, it was approved, resulting in a proliferation of limited point solutions incapable of evolving beyond their main function.
That was fine when the pandemic started and organizations just needed to bootstrap virtual care to stay afloat. But the steady accumulation of disparate point solutions created unwieldy tech stacks, and failed attempts to integrate those tools forced care teams and patients to swivel between them. The result was a frustrating and inefficient care experience.
Realizing that point solutions are a dead end for long-term virtual care vision, organizations are now shifting their attention to platforms. Unsurprisingly, many point solutions are now trying to re-label themselves as platforms to stay relevant in the market, which begs the question: what is a platform?
A platform provides a base infrastructure that unifies the many tools needed to effectively engage patients and care teams across a continuum of healthcare needs. It can connect the virtual and the in-person in one solution. And it can facilitate long-term expansion through flexibility and iterative development on top of the platform’s basic infrastructure.
In short, the platform represents a critical evolution beyond point solutions, simplifying and personalizing the care experience for patients and care teams. But how will its emergence be affected by the next major pandemic milestone?
The End of PHE: May 11, 2023
After more than three years, May 11 will bring the PHE to an end. Which changes are ending with it, and which will remain? The impact can be divided into three primary categories:
1. Temporary Changes Ending Immediately
The ability to prescribe controlled substances without an in-person examination (there is a proposal to permanently change this requirement, but it leaves a lot to be desired);
Patient copayment waivers for telehealth and remote monitoring services;
Remote monitoring availability for non-established patients; and
Relaxed HIPAA enforcement (all tools must once again meet all HIPAA requirements).
2. Temporary Changes Ending No Later Than December 31, 2024
Telehealth can be billed no matter where the clinician or patient is located;
Audio-only telehealth will be reimbursed;
Expanded list of professionals eligible to provide telehealth;
Hospital at home program;
Payment parity for telehealth services; and
Virtual direct supervision.
3. Permanent Changes (for Behavioral and Mental Telehealth Services Only)
These services can still be received in a patient’s home;
No geographic originating site restrictions; and
Audio-only permitted.
Clearly, the ground is about to shift beneath our feet again, threatening some of the advances the industry has made over the last three years. But much of that uncertainty centers around fee-for-service interactions — virtual care’s potential to foster value-based care models and drive significant ROI for medical organizations remains unquestioned.
To navigate the latest changes and protect their financial footing, organizations will need to be strategic about providing in-person versus virtual care, and they’ll need solutions that can seamlessly integrate the two. They’ll need solutions that truly support short-staffed care teams by reducing administrative burden and closing gaps in communication. They’ll need platforms.
Seizing the Virtual Care Future: A Case Study
A well-designed virtual care platform empowers a more consistent, higher quality care experience. We have seen this firsthand at Carium.
When one of our customers — a bariatrics group at a large, nationally known hospital system — created a care journey to help patients with weight management interventions, their original workflow was paper-based and time-intensive for staff. Keeping track of patients’ daily progress required a multitude of phone calls, surveys, and other manual interactions.
Through the Carium platform, the bariatrics group automated this process, moving those care journeys from paper to an easy-to-use digital experience. Using Carium’s Care Pathways, the group easily integrated the tools and data needed to make those journeys successful. Stronger virtual connections led to more reliable insights for care teams and patients who felt truly cared for throughout the program.
Care team efficiency is a particularly powerful business driver today, given the uncertain economy and ongoing staffing shortages. Eliminating unnecessary visits and repetitive administrative tasks helps our customers do more with less. That’s the power of virtual care.
What Happens Now?
Don’t wait for the PHE to officially end before you begin mapping out your virtual care strategy. Those who proactively seek out effective virtual care solutions will continue to evolve in the wake of the PHE’s demise. The rest may find themselves stuck in 2020.
Need some help finding the right solution that will deliver tangible results and immediate ROI? Download our overview of five key business drivers that should guide your decision-making. And remember — always looks for results.
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