In the continuing quest to reduce health care costs and make care more accessible, a new type of health plan has been taking shape: The virtual-first health plan.
These rapidly evolving plans integrate virtual care delivery models into a comprehensive health plan that encourages enrollees to access virtual care with their doctors before resorting to an in-person visit.
These plans are coming to market as Americans have gotten use to virtual visits with their doctors during the last three years of the COVID-19 pandemic and virtual care becomes more common even in traditional health plans.
While the uptake is still quite small — 6% of employers surveyed in 2022 offered these plans — it’s expected to grow quickly over the next few years.
All of the major health insurers in the U.S. have already announced various tie-ups with virtual care providers and tech vendors to improve their telemedicine offerings, and the uptake will continue growing as employers and their workers grow more comfortable with the plans.
A recent survey by Mercer found that, among organizations with 500 or more employees:
- 52% plan to offer virtual behavioral health care in 2023.
- 40% plan to offer a virtual primary care physician network or service in 2023.
- 21% already offer virtual specialty care, like for dermatology, diabetes or musculoskeletal issues.
There are a number of benefits to virtual-first primary care:
- Easier access — Virtual care is ideal for people with health problems that make it difficult to see their doctor or who do not live near a hospital or doctor’s office.
- Reduced costs — Telemedicine visits cost less than in-person visits, and they can yield additional savings through technological efficiencies.
- Convenience — Enrollees don’t have to drive to the doctor’s office, contend with traffic or sit in the waiting room — and they can meet with their doctor from the comfort of their home.
- Better health outcomes — Virtual first plans will often put a premium on health records integration across the care spectrum to ensure that care team members have access to them, which can help them provide better clinical and administrative support.
How they work
Virtual-first health plans include the same coverage as traditional health plans, including fee-for-service, health maintenance organizations and preferred provider organizations, but they focus on directing enrollees to telemedicine options for their doctor’s visits.
The key difference is that they aim to significantly reduce costs by incentivizing enrollees to seek out virtual care first through plan design, incentives and advocacy. Consultation sessions can often be performed virtually, saving both the patient and doctor time, while reducing the costs for each visit.
Virtual-first plans incorporate the same arrangements as traditional health plans, except that most doctor’s visits will be online, or via a smartphone app. When a patient needs to see their doctor, they’ll schedule the visit on their account — and they’ll need to opt out of a virtual visit if they feel that they need to see the doctor in person.
Additionally, if possible, specialist visits can also be conducted on the app or website.
The takeaway
Virtual-first care plans are an evolving product and it’s important to find a plan that can truly save you money while not sacrificing quality of care.
These plans are still in their infancy and are hitting the market in increasing numbers. But because they are new, there is no uniform standard for them. The most important aspects to look for in these plans are strong member engagement and seamless integration to ensure quality of care.
Give us a call if you’re curious about these plans, to find out if carriers in the area are offering them and, importantly, whether they are a good fit for your organization.
