Payers Need Clear Outcomes Data to Reimburse Digital Health, Experts Argue

Payers Need Clear Outcomes Data to Reimburse Digital Health, Experts Argue
Payers Need Clear Outcomes Data to Reimburse Digital Health, Experts Argue


From Left to Right: Yuri Goryunov, William Brady, Alyssa Jaffee and Stephen Smith

The pandemic prompted a great need for technology-enabled care delivery, so the regulations surrounding reimbursement for these services were tossed out the window in 2020. Now that the public health emergency has ended, the healthcare industry has to figure out how it is going to pay for digital health services going forward.

It’s clear that services like telehealth and remote patient monitoring have potential to provide value, but hospitals and digital health companies need to show payers clearer evidence of the outcomes these care modalities can produce, panelists argued during a Wednesday session at MedCity NewsINVEST conference in Chicago.

The pandemic proved that providers could deploy digital health services at scale, and the industry saw that these models have significant potential to reduce costs and increase accessibility, said Alyssa Jaffee, partner at 7wireVentures. It’s not as if these care modalities are going to disappear from the healthcare ecosystem — as Jaffee declared, “you can’t put the toothpaste back in the tube.”

From her perspective as a venture capitalist, the regulatory environment has some catching up to do.

“We know that [digital health services] are providing better outcomes at lower costs. And so we’re waiting, more or less, for some organizations to catch up on creating the right infrastructure to provide the reimbursement structure that makes the most sense for everybody — not just for the health plan, but also for the provider, for the companies supporting care, and for the consumer,” Jaffee argued.

William Brady, senior vice president of quality and performance improvement at UnitedHealthCaregave a payer’s perspective on what the future of digital health reimbursement will look like.

Some of the technology-enabled care modalities that were reimbursed during the public health emergency will “fall off” if they fail to “provide a compelling and data-driven rationale” of their value, Brady declared.

In order to prove that these services are worthy of reimbursement, providers will have to be specific about which populations these care models are creating value for, he said.

“Depending on the payer structure — commercial, Medicare and Medicaid — there are a lot of different value levers that provide value to the member as well as the payer itself,” Brady explained. “If you’re trying to provide something that serves Medicaid patients, you have to understand that hierarchy and how value is distributed down the chain —it’s different from Medicare.”

Being able to provide specific, clear measures of outcomes will determine reimbursement status, the panelists agreed. Jaffee said her philosophy is that ideas are worth nothing —innovation and execution are everything.

“I readily tell people my ideas — I have a list of a dozen companies I would love to see started. There’s no pride of ownership of an idea, especially in healthcare. It’s not that hard to figure out what the problems are — they’re everywhere,” she declared.

The healthcare industry is certainly aware of the idea that technology-enabled care delivery can improve outcomes and reduce costs, but providers need to produce the numbers to back up these claims before they earn widespread reimbursement for these services, the panelist argued. The panel — moderated by Yuri Goryunov, a partner at McKinsey & Company — also included Stephen Smith, CEO of mental health startup NOCD.

Photo: MedCity News



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