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The Future of Medicare & Medicaid and What that Means for Your Practice

The coronavirus pandemic has turned our lives upside down, forcing organizations around the globe to adapt to changing circumstances and create new ways of doing business. Driven by circumstance, digital transformation is happening at an unprecedented rate, particularly in the healthcare field. Electronic health records, virtual doctor appointments, and remote patient monitoring have suddenly become standard operating procedure – the new normal in a time that is anything but.

While it’s hard to predict exactly what post-pandemic medical practices will be like, one thing is clear; telehealth is here to stay. And that is excellent news for patients and healthcare providers dealing with the Medicare and Medicaid systems.

The use of telehealth is not only more convenient and more efficient for doctors and patients alike, it can lead to improved health outcomes and measurable cost savings. In a system where patients with multiple chronic conditions make up 15% of Medicare and Medicaid patients but represent 50% of spending, the bottom-line benefit of incorporating virtual care is significant.

Many users already take advantage of digital tools and mobile apps to enroll in Medicare or Medicaid, and to manage their account information and coverage. However a 2018 Deloitte survey found a significant percentage of Medicaid beneficiaries are also embracing digital health tools in a number of ways that can have a direct impact on health outcomes:

  • refill prescriptions (48%)
  • measure fitness and health improvement goals such as exercise, diet, weight, and sleep (37%)
  • monitor health issues such as blood sugar, breathing function, and mood (27%)
  • receive alerts or reminders to take prescriptions drugs (24%)
  • measure, record, or send data about a prescription they are taking (24%)

One of the biggest changes from the Centers for Medicare & Medicaid Services (CMS) affecting how medical practices may provide care in the future is the recent expansion of coverage for telehealth and virtual care. Prior to a waiver issued on March 6, 2020 in response to the COVID-19 crisis, Medicare could only pay for telehealth on a limited basis. Now a range of providers including doctors, nurse practitioners, physiotherapists, clinical psychologists, and clinical social workers can offer telehealth services and virtual consultations to their Medicare patients.

What could that mean for your practice? Increased patient volume, increased demand for virtual visits and increased demand for paperless services such as new patient registration, prescription refills, and referrals for testing.


When preparing to meet the anticipated demand for virtual care from Medicaid and Medicare clients, clinics should invest in a few key areas:

  • Training for administrative staff and healthcare providers
  • Upgrading hardware and internet service
  • Digitizing intake, medical history, and referral forms for easy online completion
  • Sourcing a software provider, ensuring the entire process from registration and appointment booking, virtual consultations, prescriptions, monitoring, and follow up operate seamlessly with your billing and electronic patient records management systems.

The CMS may have opened the door to telehealth as a temporary measure in response to the pandemic, but the benefits in terms of efficiencies, cost savings and improved patient engagement will be permanent.

Are you ready? Ambir can help. Contact us today to learn more about our healthcare solutions designed with your digital transformation in mind.