The promise of primary care on improved health outcomes has been proven over time. At the core of this equation is a robust and longitudinal patient-provider relationship. These positive relationships often improve patient satisfaction, yielding higher engagement and utilization of primary care services. However, recent studies suggest people are not engaging with primary care.
In fact, internal Teladoc Health data has shown that 80% of members do not have a strong relationship with a primary care provider (PCP). Because primary care is a key enabler of prevention, wellness and chronic condition management, the shortcomings of the primary care relationship could lead to more vulnerable populations and limit the potential benefits for patients.
A different approach to primary care is in order. Virtual primary care can address challenges in traditional care and help fill existing care gaps. And now, organizations, providers and consumers appear ready to embrace it more than ever. Virtual primary care amplifies value in several ways including:
– Increasing time spent with a provider and reducing wait times
– Earlier detection of chronic conditions and better management for patients with multiple chronic conditions
– Lowering costs for members and employers
– Expanding access, enabling more members to engage with primary care
– Comprehensive care coordination to help members navigate the healthcare ecosystem
Virtual primary care embedded in a virtual-first health plan also offers a novel alternative for employers and health plans to curb rising healthcare costs, while improving outcomes and driving member engagement and satisfaction.
Rather than adding tele-consults onto a traditional plan menu, virtual-first plans create a benefit design that is optimized for members who prefer a virtual front door to care, which studies show to be an ever-increasing percentage of the population. This enables plan sponsors to tailor design and engagement strategies for populations that have self-identified as being promoters of virtual care and achieve cost and quality measures in doing so.
“Virtual-first” doesn’t mean “virtual-only”
In this nascent category, virtual-first health plans can take many forms. However, some common factors are starting to emerge. Virtual-first health plans have a particular emphasis on the PCP as the “quarterback” for care, who develops a longitudinal relationship with the member (versus an on-demand provider) to deliver highly coordinated care. Virtual-first health plans offer the same benefits as traditional plans while incentivizing virtual visits and this enhanced care coordination element. Members who select a virtual-first health plan still have access to traditional care, as care teams help them find high-quality and low-cost providers within their network. Ensuring the non-virtual aspect is seamless is a foundational element of a successful virtual-first plan.
A virtual-first health plan seems tailor-made for tech-savvy millennials. But what about other generations? We see virtual-first health plans appealing to all employees who have no relationship with a PCP or lack a high-quality relationship with a provider—a patient population that represents a sizable portion of the U.S. workforce. Adults who went at least a year without a single visit to a primary care provider increased from about 38 percent to 46 percent.
For providers, a virtual-first health plan often provides a care team that helps members navigate to the resources they need. This approach also removes the documentation and administrative overhead from providers, allowing them to spend more time with their patients during a visit.
An oasis in a primary care desert
Millions of people live in primary care deserts, where PCPs are few and far between. As PCP visits have declined—even among those who have health benefits—people visit high-cost urgent care sites or the emergency room as their de facto primary care. Virtual primary care can provide PCP access from anywhere in the U.S., which in turn can help members get the upstream care they need, preventing visits to the emergency room due to treatment delays and suboptimal management of chronic conditions.
Virtual-first health plans could foster cross-modality models of care, allowing members to access lower-cost settings of care or lower-cost providers of equivalent quality. The technology to remotely provide some screening procedures already exists and is only getting better.
Nationwide virtual access can also build health equity. For example, with virtual primary care, a person in New York City and a person in rural America get the same high-quality experience. In addition, virtual-first health plans can offer translation services to further accommodate member needs. These models also send devices and services into the member’s home, which they may not have previously been able to access.
A market primed for virtual-first
Americans have already realized the value of virtual care. When the COVID-19 pandemic closed medical offices, consumers turned to digital options en masse—some for the first time —and saw the benefits of virtual visits. Research indicates that consumer use of virtual visits has grown by a factor of four, from 11 percent to 46 percent, since the pandemic began.
As for providers, the proportion of physicians who said they have held a virtual consultation since the pandemic began had almost quadrupled, from 22 percent to 80 percent. In the same time frame, 68 percent of physicians told researchers they were personally motivated to increase the use of telehealth in their practice. Seventy-one percent said their organization’s leadership was motivated to do the same.
Looking to the future, employers will need to rein in healthcare costs while providing benefits that attract and retain the best employees. Employers and employees have shown an appetite for innovative plan designs. In the decade between 2007 and 2017, enrollment in high-deductible health plans increased from 17 percent to 43 percent among adults aged 18- 64 with employment-based coverage. Enrollment in traditional plans decreased over the same period.
Forward-thinking health plan providers and purchasers are offering virtual-first health plans, and pandemic-seasoned employees are ready to use them.
The healthcare ecosystem is evolving, and it’s clear that improving health outcomes will require considering the centrality of virtual solutions in plan design as an opportunity to address consumers’ needs and transform the quality of primary care.
About Robert Bressler
Robert Bressler is the senior vice president of Primary260 at Teladoc Health where he is responsible for the overall growth and direction of Teladoc Health’s primary care solution (“Primary360”). Primary360 enables consumers to live their healthiest lives by realizing the many benefits of primary care through an ongoing relationship with a PCP in a model that is fully supported by a comprehensive care team. With Teladoc Health since 2013, Mr. Bressler combines his depth of knowledge and experience in healthcare product and go-to-market strategy, business development operational delivery and execution to transform how people experience care.
