Virtual-First Health Plans, Explained

The following article was originally posted on the?Mercer US Health News blog .?You can find this article along with more health news content?here .

By Rob Fouhy. Senior Manager - H&B Consulting and Beth Umland, Director of Research, Health, Mercer

Virtual care delivery is entering an exciting new phase in which its full potential may finally be realized. It’s the dawning of the era of the virtual-first health plan, now coming to market rapidly. In simplest terms, virtual health plans (VHPs) integrate virtual care delivery models into a comprehensive health plan using plan design, incentives, and advocacy to encourage member use of virtual care before accessing a brick-and-mortar facility.

A natural progression

If that still sounds futuristic to you, consider how much virtual care you may already offer. Traditional telemedicine was only the beginning. Over time, many healthcare needs have come to be addressed virtually: primary care, behavioral health, chronic condition management, complex condition support, and specialty care. In a recent?survey ?of over 700 employers, the majority of respondents with 500 or more employees say they will offer some form of virtual care beyond traditional telemedicine in 2023. Over half (52%) will offer virtual behavioral health care, and 40% will offer a virtual primary care physician network or service. Virtual specialty care, such as for dermatology, is offered by 21%. Employers also offer a range of virtual health solutions that address specific health conditions such as diabetes or musculoskeletal issues.

Virtual-first health plans seek to integrate -- and optimize – all of these digital/virtual care modalities to provide a superior member experience and realize cost efficiencies. While relatively few employers so far have taken the leap – 6% of respondents currently offer a VHP through their health plan and another 1% through a standalone, tech-forward vendor – survey results suggest those numbers could double by 2024. Nearly half of large employers say they need to better understand this new model before they could consider it; only 39% are not interested or don’t believe it would be a good fit for their organizations.

What’s different, and not so different, about virtual-first health plans

Let’s start with what’s not so different. Quality primary care is essential to good health outcomes; it is longitudinal, comprehensive, and integrative, and addresses the individual in a holistic way. Virtual health plans start with a virtual primary care solution where members have a consistent care team, similar to a team in a brick-and-mortal medical practice, who they get to know and who knows them. What’s different, of course, is how members access their care team.

Here are some of the reasons why we think virtual-first care may be the solution that hits the bullseye on some of the greatest challenges in healthcare:

• Better access to care:?Virtual primary care allows for better access for underserved markets and for safe use when someone is sick.
• Cost savings:?Virtual visits should cost less than in-person visits with additional potential for savings from better navigation to high value, in-network providers and ecosystem partners.
• Health improvement:?An ongoing relationship with the same doctor allows for longitudinal, consistent care; and many VHPs incorporate remote monitoring of vital signs/biometrics, health check-ins and reminders.
• Member convenience:?Comprehensive primary care delivered online via a secure, HIPAA-compliant mobile and web app allow members to access care when they need it.
• Better quality of care:?Solutions employ providers who are specially trained and practice virtual primary care full-time. Records are integrated across the clinical and health plan ecosystem using software and machine learning tools that provide clinical and administrative support by multi-disciplinary teams.

A role for VHPs in improving health equity

Given that VHPs are designed to improve access to care and provide more affordable care options, it’s easy to see a link to efforts around improving health equity. VHPs may serve as another tool to help tackle health disparities and an important component in an organization’s overarching DEI strategy. VHPs could help with:

• Chronic conditions:?Significant disparities persist in the prevalence of many chronic conditions. A quality VHP could improve accessibility to a PCP, making it easier for members to monitor their conditions. Closer relationships with a PCP may also result in more members getting behavioral health care when needed.
• Rural access issues:?With limited healthcare providers and resources in rural parts of the US, many people lack access to critical healthcare services. A VHP can serve to improve access for members in underserved rural areas.
• Hourly/shift workers:?Some hourly workers can’t afford to miss a shift or sacrifice an hour of work to visit a doctor, who may have limited availability. The ease of access to care VHP solutions can provide may be particularly valuable to these workers.
• Caregivers:?The convenience and access VHPs offer could better support employees serving as caregivers, who may find it difficult to make time for health care during or after work hours.
• Low-wage earners:?Adults across the country forgo necessary health care or cease taking life-saving medications due to cost. Primary care and other services initiated virtually should cost members less out of pocket, and navigation services will divert members away from ER or urgent care when it’s not a true emergency, saving them money on costly ER bills.

Of course, it’s critical that organizations review the specific features and design of a VHP to ensure it doesn’t result in adverse effects for some employees (for example, lack of accessibility features for a hard-of-hearing or visually-impaired employee, lack of technology and WiFi requirements to access virtual providers, lack of support for employees with limited English proficiency, etc.). At the same time, if there are potential pitfalls with a VHP for a segment of an employee population, there may also be ways to compensate (for example, by supplying employees with technology, hotspots, or corporate cell phones to ensure everyone can access care).

While there’s an important role that virtual-first care can play for underserved populations, these plans can go a long way to support?all?members. The need may be more pressing for some, but who doesn’t benefit from more convenient, accessible, and affordable health care options?

Keeping up with the market

The growth of virtual health plans has been quick! Driven by the COVID-19 pandemic, the market has accelerated the development of these types of service offerings. By the end of 2021, all of the major carriers had announced partnerships with providers and other vendors to roll-out digital health offerings of varying depth. Not surprisingly, there are still many unknowns about these solutions and, with so many VHPs coming to market so quickly, it’s hard to know which might be a good fit for your organization. Understanding the key elements of a successful VHP – proper member and client education, strong member engagement, and seamless integration – will be essential in determining whether a virtual-first health plan will support your members in the way you would want it to.