Unlocking Better Health: The Impact of Digital Innovation on Physician-Patient Relationships

The New England Journal of Medicine, in NEJM Catalyst, explores what the authors have christened the digitally enabled care framework (DEC). This transformative approach enhances healthcare and strengthens the physician-patient relationship, addressing current challenges such as physician burnout and patient engagement.

The DEC framework integrates digital technologies to improve the quality and efficiency of care.

It is evolving and maturing through technologies, workflow solutions, data integration, and payment models that incentivize providers and patients.

NEJM Catalyst Abstract: https://catalyst.nejm.org/doi/full/10.1056/CAT.24.0065

Beyond Virtual Visits:

While the pandemic rapidly accelerated virtual visits, DEC envisions a more holistic model beyond telehealth. It integrates digital tools into the pre- and post-visit stages to engage patients, reduce physician workload, and improve health outcomes.

Post-Visit Support: Post-visit care is crucial for adherence to treatment plans. By leveraging digital tools, physicians can provide personalized follow-up, ensuring that patients remain engaged and confident in their care plan, reducing the so-called "inbox crisis" many physicians face.

New Payment Models for an Effective DEC Framework

The paper calls for an evolution in healthcare payment models to fully realize DEC's potential. Current models are inadequate for supporting the continuous and flexible care required by digitally enabled services. To better align financial incentives with patient care, a shift towards value-based, subscription-like models is proposed.

Outcomes, not volumes

Today, most employed physicians have variable compensation incentives based on volume, calculated using Relative Value Units. Even within a value-based care environment, only 5-9% of a provider's total income is linked to activities that enable a health system to achieve quality, cost savings, and other key metrics. These same metrics can be the difference between profit and loss within a value-based care environment.

Health Systems need to align provider incentives more closely with value-based care programs, where metrics on quality, patient satisfaction, cost savings, and outcomes contribute to variable compensation - not volume.

For example, a subscription-like or capitation model would allow healthcare physicians and key providers to receive a fixed payment per patient under their care.

This approach would encourage providers to leverage the DEC framework to deliver care asynchronously or through digital means such as telehealth, messaging, and remote monitoring. With an aligned incentive plan, DEC technologies and services can improve overall patient outcomes rather than focusing solely on RVUs and volumes.

Bundled payments that cover all services related to a patient's care over a certain period would incentivize practices to integrate various digital tools. For instance, this model could include all pre-visit, visit, and post-visit care, with additional incentives for patient education, remote monitoring, and follow-up. This structure encourages physicians to utilize technology to deliver comprehensive care without increasing administrative burden.

Value-Based Incentives:

Incentives based on quality metrics should be incorporated to ensure that digital tools like remote monitoring and chronic disease management (CCM and RPM) are used effectively.

Physicians would be rewarded for meeting specific benchmarks, such as improving chronic disease management, reducing hospital readmissions, or enhancing patient engagement. This aligns financial incentives with patient outcomes, motivating providers to invest in technologies that drive better health.

Expanded, Flexible Service Codes

Although CMS currently has billable remote patient monitoring and chronic disease management service codes, they can be expanded to better align with the value-based care model. Expanding codes only makes sense if CMS wants to see more Medicare and Medicaid patients enrolled in capitated contract plans.

For example, even with modest reimbursement values, additional billing codes could allow physicians to bill for non-traditional forms of care, such as patient education, digital follow-up, and care coordination, even if these interactions happen asynchronously. This removes the need for separate billing for each service, streamlining the reimbursement process.

Expanded Use of Existing RPM and CCM Services

Chronic Disease Management and Remote Patient Monitoring work best together, and billable CPT codes cover each service. In the DEC framework, Remote Patient Monitoring can improve care for patients with chronic conditions. Together, they power a data-driven and comprehensive approach to improving outcomes and reducing utilization for high-risk, high-cost populations.

Care providers cannot afford to ignore the critical importance of tracking the patient’s vital signs, and telephonic communication without continuous patient data is insufficient.

That makes RPM an essential and natural aspect of any successful Chronic Disease Management program.

In simple words, CCM is the care program, while RPM is the data monitoring designed to make it work more effectively.

Use Existing Billables RPM Codes for Rehab and Post-Op Recovery

Notably, remote patient monitoring programs can be utilized not just for care related to chronic conditions but also for temporary rehab care and acute care related to pre-surgery monitoring and post-surgery recovery.

By using RPM and Chronic Disease Management together, healthcare providers can implement an integrated virtual care platform - in NEJM words, a DEC Framework - that incorporates technology and services to target positive patient outcomes, including:

• Improved patient outcomes through timely detection and medical intervention
• Optimization of patient experience, including better engagement, motivation, and satisfaction
• Lower healthcare costs with fewer ER visits and hospitalizations
• Reduction in the overall stress on the healthcare system
• Greater awareness, education, and compliance among patients and their caregivers
• Additional revenue streams for healthcare providers from RPM and CCM billable reimbursements