Mercer recently published its National Survey of Employer-Sponsored Health Plans Results
, revealing some concerning forecasts for healthcare costs in 2025. The survey estimates a 7% annual increase in average medical costs for group markets. This would mark the third consecutive year of healthcare benefit cost increases above 5%, following a decade of cost increases averaging only around 3%.
This rise is attributed to several factors, including inflation, high-cost specialty drugs, and increased patient demand on an already strained healthcare system.
The good news: Virtual care is expected to remain a reliable source of value-based care. As virtual care becomes the norm for many, it offers several advantages beyond just convenience and flexibility.
How Virtual Care Can Decrease Healthcare Costs & What to Look for from a Vendor?
- No Claims to the Group Health Plan: With a standalone virtual care provider, visits should not incur claims so as utilization of virtual care increases, claims impacts decrease. Plus, employers can avoid many of the carrier-embedded virtual care woes that impact plan costs (e.g., fragmented care coordination due to carriers?being contractually obligated not to?steer, fee-for-service models that harm patient experience, lack of targeted engagement, etc.). ?
- Diverting from More Expensive Healthcare Modalities: Opting for virtual care for urgent concerns, primary care or mental health needs keeps patients from using more expensive healthcare modalities such as emergency rooms or urgent care centers. Virtual care vendors should report at least 85% of virtual visits as cost-diverting.?
- Valued-Based Preventive Care Tactics: Engaging patients in their health early on and ensuring they are up to date on age- and gender-based screenings can prevent or slow chronic condition progression. Unfortunately, according to the CDC
, most providers are paid to treat rather than prevent chronic diseases. A standalone virtual care vendor that is independent of hospital systems or carrier influence ensures the correct preventive care tactics are utilized to support healthier populations, and in turn, decrease healthcare costs. ?
- Better Chronic Care/Disease Management: Plan sponsors are bracing for an increase in medical costs for chronic disease utilization. A virtual care vendor that has no limits on virtual primary care usage allows patients to have more frequent and longer visits with a doctor to get health on track. 30%
of ER visits for those with chronic conditions are potentially unnecessary and offering convenient, quick access to a patient’s primary care physician in a virtual setting will deter them from electing expensive healthcare modalities. Vendors should have next-day appointments available, offer unlimited visits and guarantee at least 25 minutes with a doctor. 75%
of primary care visits are for those with multiple chronic conditions, however 85% of PCPs reveal they do not have adequate time to support patients with a chronic disease. Virtual primary care is a valuable resource for disease management as members spend more time with doctors to create unique treatment plans to best fit their needs. ?
- Getting Health Back on Track & Mitigating Claims Risks: Delayed
or skipped care due to the pandemic and other personal barriers increases the risk of high-cost claims to the plan. In fact, between 2021-2023, stop-loss premiums increased by 16%
. Engaging employees in their health with annual wellness exams, preventive care and hands-on disease management (as mentioned above) can reduce the risk of such claims.?
