Telehealth providers eyeing greater risk, greater returns

Several telehealth companies are negotiating potentially high-risk, high-reward contracts that give them a larger stake in patient care.

These payment systems reward them for keeping patients’ costs low and penalize them for overspending. For example, they could cover the full cost of care upfront and pocket the savings or attempt to drive down costs and share the savings later. These types of contracts, which are a departure from traditional fee-for-service, reflect the need to find novel ways to get paid for a range of telehealth offerings that don’t fit traditional billing models, such as in-app messaging and automated reminders to check vital signs.

“Many of these companies have a model where they’re having lots of touchpoints [with patients],” said Ateev Mehrotra, a Harvard University health policy professor, according to Stat. “Payments for a visit doesn’t really make sense in that view.”

Teladoc plans to gradually embrace more risk-sharing, CEO Jason Gorevic said at the JPMorgan Health Care Conference last week. Teladoc offers on-demand video visits and a range of digital programs for chronic and behavioral health. It currently earns most of its money through contracts with health plans and employers who pay a monthly per-member fee, as well as a per-visit fee for appointments.

These various types of risk-sharing agreements aim to avert expensive medical care by incentivizing providers to focus on prevention, such as managing diabetes or high blood pressure, to reduce the need for pricier and more complex care later. They also could help health plans and employers ensure that the services they pay for meaningfully improve patients’ health and reduce costs.

Agreements that hold providers accountable for patients’ health are increasingly common in the brick-and-mortar world, including for health systems and payers focused on Medicare and Medicaid patients. But many payers still reimburse per visit or per procedure, and telehealth companies billing their services as virtual doctors’ appointments may be forgoing additional payment for services that can’t easily be billed in today’s claims system.

These new types of contracts could incentivize telehealth provides to link up with brick-and-mortar providers to ensure that patients are able to access preventive care instead of simply offering one-off appointments,

“There is an opportunity to reimagine what health care looks like when it is around the patient,” said Jennifer Goldsack, chief executive officer of the Digital Medicine Society.