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Lessons from Rise West

Our Team Recently sponsored the Rise West Virtual Conference and participated in several of the workshops. Several of the things we have been discussing lately were validated.

COVID is Everything

I may have missed it in the schedule, but I didn’t see a single session that in at least some way didn’t talk about the current reality of COVID-19 and the effect’s it’s had on the industry.

Every line of business and every department within health plans are reeling from the effects. Most participants seemed to be doing everything in their power to stay afloat, and help their networks of providers and members do the same.

Telehealth Telehealth Telehealth

The single biggest theme coming as a result of COVID is the shift to Telehealth. From changing rules from NCQA and CMS, to more practical issues of how certain things could be screened over a phone or video call, several issues were discussed.

The common theme in all instances seemed to be, “we’re figuring it out.” But the other important thing to note was the massive amount of provider education that is going on right now.

You’ve got the doctors attention. The health plans that maximize that opportunity by being the most helpful will cement the strongest and most cooperative relationships going forward.

Get Creative

Some of the hardest hit areas are rural areas where there was already a limited supply of providers. Now many of those providers have had to shut down. While telehealth can help with basic visits and recapturing certain Risk Adjustment codes, you can’t exactly do a mammogram or colonoscopy over a video conference.

Community partnerships with organizations like schools and churches, combined with mobile testing units are playing a role in closing these gaps. However, transportation, and the massive amount of coordination required with those limited resources is still a challenge.

Changes that needed to happen are happening

Events like the pandemic are obviously painful for everyone in some way, especially those that have suffered directly or lost a loved one. The stress of immediate and absolutely necessary change can also be a huge burden to bear for everyone in our organizations.

If there is one benefit, however, we see a lot of changes occuring that have gone from “want-to” or “would be nice” status to “have to.” Changes in telehealth rules have needed this for a long time. The level of engagement with members and providers going from merely transactional and “efficient” to empathetic and “effective” has been another.

 

And as our Director of Business Development said in one of the presentations, health plan members still need us all, and those health plans that seize this opportunity for improvement will be coming out even stronger when things get back to “normal,” whatever that new “normal” will eventually look like.

 

In service,

John

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