New Toolkit Aims to Help Telehealth Programs Negotiate Payer Reimbursement

An organization focused on assisting healthcare providers with virtual care platforms has released a resource for negotiating third party payer reimbursement.

The Payer-V1C Contracting Toolkit is designed to support virtual-first care solutions, which have been springing up across the country in the wake of the pandemic. Many healthcare organizations shifted to telehealth to reduce in-person care during the pandemic, and some have decided to prioritize virtual care going forward.

“We have an unprecedented opportunity to scale V1C as an option for all patients,” Claire Meunier, chief operating office for the Digital Medicine Society (DiME), said in a press release issued last month. “Yet there is currently a critical friction point: payers need to be able to contract with V1Cs as easily as they can contract with providers and vendors. Aligning payer systems and contracting processes will drive more deals and continue the expansion of V1C. Without this, V1C’s promise risks being limited to direct-to-patient or only the most progressive self-insured employer models, falling woefully short of its potential.”  

DiME, a Boston-based digital medicine organization launched in 2019, partnered with the American Telemedicine Association to create the IMPACT (vIrtual-first Medical PrActice CollaboraTion) initiative this past January, offering support for providers who’d launched or were looking to create virtual-first platforms. IMPACT unveiled the Payer-V1C Contracting Toolkit last month.

Connected health advocates have pointed out that while virtual-first is becoming a popular strategy, particularly with providers who want to reduce costs associated with maintaining a physical site like an office or clinic, it needs support from insurers to ensure sustainability.

The toolkit includes a guide to payer-V1C contracting, a guide to payment models that support virtual-first care, and a library of billing codes that address virtual-first care.

“Our usual contracting approaches require us to classify a solution for contracting as a provider or a vendor, and we work through many revisions to make the contract fit what the V1C solution is offering and to pay for V1C services,” Marcus Thygeson, Chief Health Officer at Bind Benefits, a member of IMPACT, said in the press release. “IMPACT’s work on the Payer-V1C Contracting Toolkit provides a third path payers can take, and presents an opportunity for more effective contracting as we lean into the V1C category.”