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» Incorporating Virtual Health in a Benefits Plan

February 2, 2022

Behavioral Health, Digital Health, Employee Benefits, Health Equity, Healthcare Innovation, Healthcare Spending, Research, Telehealth

Consumerism and technology are continuously ramming into each other and disrupting every industry. Healthcare is no different.

Benefits plans in 2022 and beyond must include a virtual health solution front and center as one of employees’ first entry points to healthcare.

Virtual care usage shot up significantly since March 2020, as virtual care visits increased 50 percent. While virtual care used to be a novelty, consumers are now using it more than ever before and it’s here to stay – it’s estimated that 1 in 3 future visits will be virtual.

We expect it to play a central role in how employees interact with the healthcare system and we believe groups need to embrace this trend, as it will shift care delivery and impact spending.

Click here for a complimentary discussion with a consultant about your health plan’s virtual care today!

What is Virtual Care?

Virtual care is healthcare delivered with technology without the patient and provider meeting face to face. This care can be synchronous or asynchronous, carried out through a live audio or video visit, or messages delivered by the provider.

Virtual care opens up interesting new ways of connecting and treating patients. While virtual care started as an easy way to treat patients with conditions that weren’t life threatening and lower risk, it has evolved into a sophisticated form of care delivery for nearly every patient.

Remote patient monitoring can deliver health data directly to providers for evaluation and treatment in real-time. Patients can connect with a provider within minutes of a health incident. And providers can communicate with patients in a more comfortable and responsive environment – what will a doctor notice on video with a patient at their home that they wouldn’t if the visit was in an office? They can discern fall risks, environmental hazards, and more that may otherwise fall through the cracks.

In 2020, McKinsey predicted $250 billion of spending in US healthcare could shift to virtual care.

Forms of Virtual Care

Virtual Urgent Care: patients with non-emergent conditions such as rashes, sinus infections, and more can speak to a provider, share photos, and receive prescriptions with much less friction than traveling to a nearby physical urgent care facility.

Virtual Primary Care: Whether routine or preventative care, patients can see their primary care physician on a more regular basis (again, less friction) and stay on top of any health trends relevant to their health plan. Providers can obtain more consistent data with the aforementioned RPM opportunities. And virtual primary care can also utilize full care teams such as nurse practitioners, registered nurses, pharmacists, physical therapists, nutritionists, and more. A holistic, well-rounded care team can be designed for a patient panel and deliver high-quality care with less breakdowns than in-person-only primary care delivery. And because a variety of providers are used to meet each particular need of a patient, virtual primary care can do this all at lower overall costs.

Virtual Behavioral Care: mental and behavioral health have been a particularly tricky area of healthcare to solve. While certain areas of healthcare such as cancer care, heart disease, stroke and more have seen vast improvements over the last few decades, mental health has been hard to solve.

Mental healthcare has struggled with friction, accessibility, and affordability for years. Promisingly, virtual behavioral health is poised to solve this, along with novel drug therapies in the pipeline.

One example of the issues plaguing our existing mental health environment was an employee at a client group who I learned was seeing a therapist virtually in Hawaii, while they were in California. One of the reasons for this? The Hawaiian therapist was 3 hours behind and could therefore visit with the employee after 6 pm their time, outside of work hours.

Virtual behavioral care can solve these kinds of frictions and accessibility issues.

Virtual Specialty Care: Virtual care is not just for preventative and primary care – specialty care stands to benefit from virtual care as well.

A dermatologist can receive periodic pictures from a patient. A speech therapist can deliver speech therapy, physical therapists can prescribe exercises and correct form, and have follow-ups with specialists like burn surgeons or endocrinologists.

Patients can receive these services in a lower-cost virtual care setting and may adhere to treatment plans more stringently for better outcomes. This can reduce spending for the health plan in a serious way, both in the short- and long-term.

Concerns for Virtual Care

Does virtual care actually save money? Skeptics point to key issues with virtual care that must be solved for it to realize its long-term potential.

Duplicated care: if a provider can’t make a diagnosis virtually, the patient must come into the office to see the provider for an evaluation. Should the patient pay copays for both visits?

Diagnosis accuracy: If providers can’t make as accurate of diagnoses virtually due to exam or tool limitations, what is the acceptable drop-off? How many more errors or incorrect diagnoses done virtually are acceptable?

Overuse of prescriptions and other interventions: How may provider behavior and recommended treatments change if more visits are conducted virtually?

A study in the journalĀ Pediatrics from 2019 suggested that physicians who treat children via telehealth for respiratory tract infections were prescribing too many antibiotics. And to make matters worse, incentives were not aligned in this case, as those doctors who prescribed antibiotics were found three times more likely to be given a five-star rating by patients.

Providers may prescribe more medications virtually to speed up the visit and make patients feel better, although there are concerns about the overuse of antibiotics among children.

A similar study in JAMA Internal Medicine contained the quote “because patients often expect to receive antibiotics, physicians may believe that explaining why they are unnecessary is more time-consuming than simply prescribing them.”

Opportunities for Virtual Care in Your Plan

Virtual care can deliver on key performance metrics for your health plan. Thes include:

  • Lower costs than in-person visits: with claims data, we can measure the average cost for a virtual care visit compared to a provider visit, a specialist visit, or a visit to an urgent care facility.
  • Greater accessibility to healthcare services: an issue with many plans and their population health management has been how to reach their most unengaged populations? Virtual care is convenient and can deliver timely care
  • Improved outcomes: Virtual visits may reduce the need for lab work, reduce duplication of care in urgent care visits, and reduce the number of follow-up visits for conditions.
  • Right care at the right time at the right place: With an integrated healthcare ecosystem, patients get the right care they need at the right time and place, which manages their costs effectively and improves their outcomes.

An optimized plan maintains or improves outcomes at the same or lower overall cost. Virtual health is a mandatory strategy for a health plan to be operating at its highest level. And employees like it, to boot!

Click here for a complimentary discussion with a consultant about your health plan’s virtual care today!

Posted by in Behavioral Health, Digital Health, Employee Benefits, Health Equity, Healthcare Innovation, Healthcare Spending, Research, Telehealth