Navigating the Future of Virtual Chronic Care Management

Brian Esterly, CEO, TimeDoc Health

Please introduce yourself by stating your name, title, organization, and relevant professional experience.

I am Brian Esterly, CEO of TimeDoc Health, a virtual care management (VCM) company that provides chronic care management, remote patient monitoring, and behavioral health integration services. I have spent the past 30 years in health care with the last 20 years working with tech-enabled health service companies. Most of my time has been spent serving elderly populations with services provided virtually or in their homes. Functionally, I have fulfilled both chief growth officer and chief operating officer roles.

Some of my more notable previous experiences include Matrix Medical (acquired by Providence Services Corporation), ExcelleRx (acquired by Omnicare), and Aspire Health (acquired by Anthem, Inc.).     

Could you offer insights into the 2024 Medicare Physician Fee Schedule and discuss the potential implications of these fee changes?

The current Medicare Physician Fee Schedule brought many significant changes to increase access to much-needed virtual care management services for underserved populations. Specifically, we believe patients who receive care at federally qualified health centers and rural health centers (FQHCs and RHCs) deserve access to the technology and services that extend their provider’s care outside the 4 walls of a clinic, just as their peers do at non-FQHCs/RHCs. 

Key changes include:

• Reimburses Remote Patient Monitoring (RPM) services delivered through FQHCs (page 763). All patients deserve access to the technology and services that enable better self-care management of chronic conditions and access to clinical monitoring. This new reimbursement helps improve access to these important services and optimizes outcomes. 
• Multiple services reimbursed in the same billing period under the G0511 service code for FQHCs and RHCs (page 781). Given the wide range of services listed under the general G0511 service code, providers need to submit claims for multiple services under this code. This is the only way for the full needs of the patient to be met (based upon medical necessity) and the outcomes to be optimized. Conversely, allowing only one service code per month will deny patients access to services vital to their health.

It is important to note that suggestions in the media that this change constitutes double-billing are incorrect and misinformed. These are discreet services, and the requirements for each service must be met to qualify for reimbursement. No double counting of time, for example, is allowed. 

There was a reduction in the reimbursement rate for G0511 from $77.94 in 2023 to $72.98 in 2024 (pages 775-782). This reduction is compounded by the inflationary pressure providers experience in hiring, training, and retaining talent, as well as the increased service delivery costs of providing patient services. That said, this decrease is offset by the positive advancements noted above. 

With Medicare’s recent push to improve chronic care, how have their efforts impacted providers?

For providers, the emphasis on chronic care results in a paradigm shift where providers move their focus from episodic treatment to longitudinal care management. Patients’ treatment plans must be integrated, ongoing, and actively managed. The increase in value-based care arrangements further reinforces the focus on proactive chronic care management to improve quality, satisfaction, and outcomes. 

Provider organizations may or may not be adequately equipped for this paradigm shift and that is where organizations such as TimeDoc can help. We reach beyond the walls of the practice to function as extenders for providers and we offer continuous patient support. 

Provider organizations are facing the one-two punch of increased patient disease burden and the aging of the patient population at precisely the time there is a decrease in the number of providers and an acute provider shortage has emerged. The ability to leverage technology and extenders such as care coordinators becomes more critical in this environment. 

A recent KFF article stated that "Health policy experts say a host of factors limit participation in the program." What is your perspective on this statement?

The factors represented in the article do represent barriers to accessing services such as a) voluntary opt-in enrollment, b) significant administrative requirements to ensure compliance with the service requirements, and c) a workflow not aligned with a practice’s visit-oriented operating procedures. There are other barriers as well, such as patient cost-sharing which adds a financial burden to patients. Another barrier is stringent service requirements that don’t improve the clinical outcomes but do represent a barrier to accessing services.

These are key reasons why organizations such as TimeDoc exist. We have a purpose-built proprietary technology workflow platform that documents encounters, ensures compliance with service requirements, and integrates with all major EHR platforms. Our care coordinators do nothing else but VCM services, so they are trained and experienced in these areas. They collaborate closely with the practice staff and represent seamlessly to the patients. 

Collectively, this service delivery model makes it easier for providers to serve a larger percentage of their patient population without increasing staff or incurring service delivery burdens. 

When reading our patient success stories about changing patient lives through these services, it is encouraging to note the impact we can have - whether it is getting access to medications, scheduling appointments, identifying and gaining access to community resources, or a myriad of other ways in which care coordinators help our patients. The patients we serve need us and it behooves us to serve in as many as we can. We also have seen great results to demonstrate the value of the services we provide, such as a 34% reduction in low-acuity ER utilization, a 40% increase in CKD screenings, and 81% of colorectal cancer screening gaps closed.

What impact does the recent CMS initiative to improve chronic care have on small practices?

The challenges outlined previously are similar for small practices but more intense. They may be more resource-constrained (staff limitations), be less technologically developed, and have a lessened ability to adapt to the workflow requirements. Often these types of challenges can also be acute in rural settings, health care deserts in urban areas, and other underserved geographies and patient populations. 

The virtual and remote aspect of these services, coupled with the enduring patient support a care coordinator provides, both represent a way small practices can better support their patients. 

What is one key takeaway you hope the audience gains from this interview?

When contemplating virtual care management services, providers and payors should “Just Do It.” 

There is a compelling value proposition built around financial, clinical, quality, and service metrics that align well with common value-based or other incentive programs. These programs have quantified and demonstrated results. While there are barriers to operating services such as these, there are also purpose-built partners, such as TimeDoc, who can help make it easy for providers to serve patients at scale. Patients need this service and there are more and more everyday who are eligible for these programs.