Ins and outs of telehealth contract management

I recall my first telehealth visit as one might remember a blind date. It started with the email that never arrived and finished with awkwardness as my video didn’t work and my doctor’s did. I recall how the doctor sighed and mouthed, “I’ll call you,” before he ended the session. It’s hard to believe, that was only four years ago, two years before Covid-19 changed everything.

Since Covid-19 began, telehealth usage has exploded, with approximately 80% of doctors now using telehealth, up from 20% at the beginning of the pandemic. McKinsey estimates that up to $250B of the U.S. healthcare spend could be potentially virtualized. *

While the technology wherewithal was available four years ago, many doctors, like my own, were dipping their toes in the cold ocean water. The reasons were consistent when I asked, “We don’t know if insurance will pay,” and “we don’t have a telehealth system.” Behind the responses, there were payment, inconvenience, and risk issues that slowed telehealth adoption. At this point in the pandemic, most telehealth adoption barriers have been cleared, and doctors now focus not only on bedside manner but website manner. But one key challenge has surfaced – managing the complexity of telehealth contracting efficiently with the appropriate protections and business terms in place, with the following three key areas to consider in telehealth contracting.

Onboarding

Telehealth offers payers and providers the ability to expand their services beyond the brick-and-mortar walls that previously defined where and how they provided service. We see this most in the mental health space, where a provider can practice remotely. As someone who lost a young son, I know that mental health workers with a child loss specialty are not always within driving distance. Telehealth opens new possibilities for grieving parents like me. A Facebook post with a recommendation and a phone call can lead to a new patient and provider relationship that was once impossible.

From a contracting perspective, this means that groups of providers often need to be credentialed, contracted, and onboarded in quick order. Healthcare players looking to expand to a new state, or a new set of specialties will need to onboard large practices or a list of doctors quickly. A large healthcare payer that uses Conga’s Contract Lifecycle Management system for its provider network has grown from operating in eight states to 20 in the last several years. Look for intelligent contracting solutions that enable automation, mass creation and amendments to handle the increased volume of provider contracts. Leading Contract Lifecycle Management solutions provide visibility into both in-flight and executed contracts allowing teams to identify bottlenecks and understand the status of a new telehealth expansion. Contract intelligence alerts users to provider contracts that have been sitting on a lawyer’s desk for days.

Pricing

Telehealth offers an interesting case for price vs. value, which perhaps has not been resolved yet and may likely take several years for the industry to solve. Over the past several years, telehealth current procedural terminology (CPT) codes were created and amended. The current list is still small and non-specific with codes 99441-99443 being time-based (i.e. 5-10 minutes). Does one value a cardiologist’s time the same as a podiatrist? More fundamental price/value questions still exist, like do patients receive the same quality of care during a telehealth visit? How do they value convenience or access to specialists? Expect to see an increase in more specific codes and an evolution of the price/value of these services.

Look for Contract Lifecycle Management systems that handle fees natively and facilitate frequent changes to the fees and codes that will evolve in the coming years.

Amendments

Oddly, one topic missing in the telehealth conversation is risk. Changes in healthcare can result in litigation as patients suffer from poor outcomes. How can providers protect themselves against a potential wave of litigation? Is the “Miranda right” saying at the beginning of the telehealth visit, “you are aware that this visit is virtual and therefore I cannot conduct a complete examination,” enough to protect providers?

As with pricing, expect a continuous wave of changes across all the contracts that cover Telehealth (Payer to Provider, Provider to Telehealth Platform, Provider to Patient, etc.). Look for Contract Lifecycle Management systems that support a robust and evolving clause library. Find systems that support the ability to amend language in executed contracts in mass. Intelligent Contract Management systems that utilize artificial intelligence (AI) identify clauses in existing contracts that may need amendment as state regulations evolve.

If you have a Contract Lifecycle Management system in place, take the influx of telehealth contracting issues to implement changes that will help avoid risk while operating more efficiently. If you are not currently using an Intelligent Contract Management system, now couldn’t be a better time to explore one that will support the growth in contracting volume and amendments that telehealth will require.

Tom Cowen is Head of Vertical Strategy – Healthcare & Life Sciences at Conga, the global leader in scalable Revenue Lifecycle Management solutions.

* McKinsey & Company - Telehealth: A quarter-trillion dollar post-COVID-19 reality? by Oleg Bestsennyy, Greg Gilbert, Alex Harris, and Jennifer Rost