Telemedicine Use Higher Among PCPs with Value-Based Payment


A study of Medicare Advantage enrollees during the COVID-19 pandemic found that telemedicine use soared among primary care practices with value-based payment models.

Telemedicine use skyrocketed among primary care practices during the pandemic, specifically for those with a value-based payment model, according to a research letter published in JAMA Health Forum.

Many patients were forced to delay primary care due to the pandemic, which resulted in significant revenue losses for primary care organizations. Telemedicine use naturally increased to make up for lost revenue and enable virtual visits.

Although fee-for-service primary care organizations appeared to have a big near-term financial incentive for telemedicine use, results revealed that telemedicine was significantly more popular among practices reimbursed by value-based payment models.

Researchers focused on over 1 million patients who were part of Medicare Advantage health maintenance organization (HMO) plans from Humana between January 2019 and September 2020, in which beneficiaries are required to choose a primary care physician.

The research team used contract data to identify an organization’s payment model and grouped them into four categories: shared savings with upside-only financial risk, fee-for-service, shared savings with downside financial risk, and capitation. Both capitation and shared savings with downside financial risk signify value-based payment models.

Paid outpatient claims allowed researchers to identify audiovisual and audio-only telemedicine visits between January and September of 2020. Weekly rates of telemedicine use signaled trends over time. The team then used a patient-level negative binomial regression model that adjusted for practice size, Medicare eligibility, comorbidity, patient age, sex, race, and ethnicity.

Despite the financial incentives of telemedicine use for fee-for-service payment practices, those with value-based payment models utilized telemedicine far more often.

“This suggests that accountability for cost, quality, and disease management under value-based payment models—and the infrastructure, technology, and management systems of organizations engaging in these models—may have been a stronger catalyst for telemedicine adoption than recouping revenue from deferred in-person visits,” the study explained.

Because value-based payment models reward practices for health outcomes rather than services rendered, it is possible that telemedicine adoption was appealing because it enabled physicians to provide preventive primary care during the pandemic and avoid worse health outcomes in the future.

The study acknowledged that further research is needed to identify the motivators behind telemedicine adoption outside of payment model and practice size.

As the country begins to recover from the pandemic, fewer primary care practices are facing financial struggles. Patient volumes are rising once again, but time will tell whether that will be enough to recover from $15 billion in primary care losses from the early days of the pandemic.

Financial losses and lower patient volumes also point to a need for primary care reform. A recent report suggested that high-quality implementation of primary care requires expanded telehealth capabilities, team-based care, and a shift to value-based payment models over fee-for-service reimbursement.

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