ChenMed

If there was any silver lining to the darkest days of the COVID-19 pandemic, it was the way it pushed the entire American health care system toward wider adoption of advanced technologies. As an industry, we’ve learned how technology can positively impact the patient journey faster than any other set of circumstances could. The learning curve wasn’t always a smooth one for many practices – but ChenMed was an exception. Our nearly 100 centers in 12 states were able to quickly transition to technology-assisted methods of delivery almost immediately. More than 18 months later, we’re still providing high-touch, high-quality telehealth care that our patients in many cases prefer to the “old way” of having to travel to and from a center once per month for preventive care visits. In this article, I’ll share insights about how we started – and sustained – a successful approach to virtual care.

Before we get too far into the discussion, let me quickly describe the funding model ChenMed operates on, because it’s an important factor in what we’ve been able to achieve with technology. ChenMed operates on a full-risk, value-based care model, also known as full-risk capitation. This involves a payment structure in which a private insurance company or Medicare enters a partnership with a health care provider. At that point, the health care provider – not the insurance company or Medicare – is responsible for paying for the patient’s health care. This is where the “risk” comes in – the provider is responsible for paying for any preventive, specialty, or emergency are the patient may require. However, if the provider is able to help the patient prevent or successfully manage chronic medical conditions – therefore avoiding costly emergency department visits or hospital procedures – the provider keeps the savings. Therefore, the incentive for full-risk capitation providers like ChenMed is to do whatever they can to help patients stay as healthy as possible.

ChenMed’s full-risk capitation funding model is pertinent to this discussion for two reasons:

- Because ChenMed operates on a full-risk capitation basis, our centers were able to transition immediately to telehealth and other delivery methods because we knew we would be compensated in the same manner for virtual visits as we would for in-person visits. Many fee-for-service providers, on the other hand, had to temporarily cease all operations because they had to wait until insurance companies and Medicare – which historically have not reimbursed virtual care at the same level as in-person care – decided whether to approve payment parity.

- Second, the health care provider’s financial incentives in full-risk capitation align with the patient’s health incentives: Keep the patient healthy, and the financial benefit will follow. Therefore, companies like ChenMed have an interest in developing and using tools, including technology, that will help care teams more effectively prevent or manage health conditions.

At ChenMed, the financial incentive to keep patients happy, healthy, and out of the hospital has fostered a culture of innovation. Beginning in 2017, the company has invested in the development of a strategic roadmap for virtual care delivery. A multidisciplinary team of internal user experience, IT development, and informatics experts work alongside ChenMed’s clinical and operational staff to develop tools for primary care physicians and their care teams.