Mark E. Lutes, Strategic Advisor, and Joel V. Brill, Strategic Consultant, co-authored an article in the Health Affairs Blog, titled “CMS Should Invite Innovators to Furnish Technology-Enabled Episodes of Care.”
Following is an excerpt:
For decades, the health care payment system has focused on measurement of physician work, time, intensity, effort, and complexity of diagnosis and treatment when establishing reimbursement. Often, the more physician work or time involved, the higher the relative value unit assigned by the Centers for Medicare and Medicaid Services (CMS), with a resulting implication for reimbursement. But that’s changing.
The “Marcus Welby” cottage practice of medicine of yesterday is not consistent with the data-driven opportunities of today and tomorrow. More organizations today seek to assess, monitor, and manage the health of populations. And they’re doing it by using the most cost-effective yet highest-qualified professionals and incorporating technology to reduce the amount of physician work involved in the episode of care. Patient conditions can be monitored remotely, clinical trends assessed, recommendations generated according to data analysis, and patients communicated with, coached, and managed according to algorithms developed collaboratively and collectively by physicians, pharmacists, care managers, and other health professionals. Machine learning algorithms can be harnessed to stratify the delivery of care by the professional level of expertise required, personalized to the needs of the individual. And much of this work need not be done by traditional providers of medical care such as doctors and hospitals. Other qualified, non-traditional suppliers—such as care and benefit management companies—can offer innovative tools and approaches.
We believe these efforts, especially as applied by new actors in service of managing chronic conditions, should be measured and appropriately reimbursed as technology-enabled episodes of care (TEEs). For too long, Current Procedural Terminology and Healthcare Common Procedure Coding System codes have not evolved to adequately track and pay for person-focused, technology-enabled care management. It’s time for policy makers to catch up with technology, exploring payment and coverage methodologies that nurture these innovations.