Financial Sustainability for Virtual Care

In response to relaxation of telehealth reimbursement rules during the COVID-19 pandemic, Community Health Centers (CHCs) have rapidly transformed in-person visits into telehealth visits that reduce the spread of infection to patients and staff. Although those rules will likely be tightened after the emergency period, it is likely that in many states, telehealth will continue to be a reimbursable option of care. To this end, health centers may consider re-designing their primary care model to expand virtual care and will need to evaluate financial feasibility. From a reimbursement perspective, CHCs in some states were already operating under a primary care capitation alternative payment methodology or able to negotiate one with payers. This provides even greater flexibility in terms of means of serving patients and choice of the most appropriate member of the care team. This workshop will explore clinical and operational considerations which may impact financial sustainability. Furthermore, it will discuss reimbursement options which could incentivize how health centers manage total cost of care in a virtual environment. Participants will learn key concepts which should be integrated into a financial modeling exercise that would serve as a business plan, and identify return on investment (ROI) for a virtual care program.