What Will the COVID-Induced Rise in Telehealth Mean for STARS and Risk Adjustment?

Posted by: user@icare | 5th Mar, 2021

A couple of weeks ago I wrote about how COVID-19 is affecting Medicare, and particularly from the health plan perspective.

Obviously this year’s reporting system is going to be wild.

But there are likely several other changes that will have long lasting effects.

The Rise of Telehealth

This was already a growing practice throughout health care, and it’s unlikely CMS goes back on the provisions that have been made for phone and video “visits” with PCPs during COVID quarantines. However, it’s not without concerns.

One of the best opportunities for physicians to engage members for true quality of care is in an office visit. The ability to asses certain symptoms that the patient may not realize are presenting along with the ability to do actual palpations, visual, and other sensory examinations are a huge limiting factor.

However, very little is going to happen if there is no visit at all. And a well-trained doctor and their nursing staff can still go a long way in detecting potential problems that may make an in-person exam necessary, while still being able to communicate other information to patients more easily through telehealth.

There is also an opportunity here for health plans that have solid provider engagement and communication with their PCP networks. If telehealth options can actually make it easier for members to speak with their doctors, the opportunities for closing quality and risk adjustment gaps also increases.

Obviously many of these gap closures can’t happen over the phone or video conference. But when members hear it straight from their doctor that they need to come in for their colonoscopy or mammogram, it’s far more effective than when coming from a Health Plan call center.

However, that will require that doctors have easy access to that information. Realistically, if it’s not in the chart for exams or wellness checks that day, even telephonic ones, it’s easy to miss that opportunity. We’ve found that the real key to provider engagement is making those reporting workflows adaptable to different practices, and ultimately able to lighten the load for providers’ staff in any situation.

These Times

I hear companies use terms like, “these trying times,” these unpredictable times,” “these certain times,” “these difficult times.”

I think those are euphemistic at best for the times we are experiencing. They are nothing short of chaotic.

I believe a lot of good will come out of this. It will force some much-needed changes in our industry with the way doctors report and work to keep our members healthy. As health plan vendors it’s important for us to help facilitate those changes.


We’re happy to do our part,



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