January 22, 2019

Health plans embrace virtual care for improved member satisfaction, cost control

By Dan Trencher, Senior Vice President, Teladoc Health

The proverbial “tipping point” for virtual care is now in our rear-view mirror.

For Health Plans, increasing member satisfaction and supporting cost control are critical to improving access to quality care – and so we see about 94% of health plans currently offer virtual services to 82% of their commercial customers (both self-insured and fully-insured), according to a recent virtual care survey of health plans conducted as part of AHIP’s Sponsored Research Program. The 28-question survey, deployed in October 2018, was administered to 117 health plans about their commercial line of business.

Even more telling, 96% of AHIP’s survey respondents expect reliance on virtual care to grow.

What’s fueling the trend?

  • Continued escalation of healthcare costs. Health plans and employers recognize that virtual care – particularly as a first step when seeking medical attention – can help drive down costs through effective care-navigation. Some issues can be addressed through telehealth, averting the need for an unnecessary office or ED visit (or preventing a costly readmission). In other instances, a virtual visit facilitates routing the member to the appropriate care (whether to a specialty virtual encounter or a referral to an appropriate community care setting) for effective utilization of time and resources.

  • Member demand for greater access and convenience. Consumerism dominates members’ world view. Just as consumers expect convenient digital access to financial, hospitality and retail services (to name just a few), so they expect it from healthcare. Plus, members are all too aware of rising costs; they are being asked to shoulder a larger portion of the bill. They, too, embrace strategies that enable greater access, efficiency and lower costs.

  • Erosion threatening provider networks. Physician shortages have become a reality – and not just in remote areas. Burnout is at an all-time high, thanks to increasing patient loads. And growing numbers of providers are “aging out” and opting for retirement. Virtual care means healthcare organizations can optimize their caregiving teams, triaging patient demand and aligning resources where they have greatest impact.

Influencing each of these three factors is acceleration towards value-based care. Virtual care has a tremendous potential for positive impact, particularly in shared-savings agreements with providers. When integrated as a key component of “smart plan” design, virtual care can begin to change consumer behavior, enabling health plans to offer lower cost, more engaging plans across multiple service offerings and lines of business.

No transformation is without challenge, however – and health plans cite a number of factors likely to impact industry-wide adoption of virtual care. Top among the obstacles, according to the AHIP survey, is finding ways to motivate members to embrace virtual care (87.2% of respondents). Acknowledging their own role, health plans recognize that identifying and implementing a comprehensive virtual care strategy (78.9% and 70.3%, respectively) are key to success. Respondents also indicated barriers might exist in marketing and communicating their virtual care efforts (65.8%).

So, where do health plans need to go from here? To achieve virtual care success, they need to ensure:

Elevated member awareness. This means education – directly to members, but also through provider networks and employers, where applicable. Members must know that these services are available, how to access them and when they are an appropriate option. Well-timed communications must promote the convenience and simplicity of virtual care, while assuring patients that virtual care enhances – not detracts from – personalized attention and quality. Select virtual care partners, like Teledoc Health, are equipped with proven, data-driven strategies and tools to improve awareness and utilization so virtual care can deliver desired results among members.

Greater breadth of services. The AHIP survey found that, in 2018, the virtual services most commonly offered were acute/non-emergency care, behavioral health, pediatric care, wellness coaching, nutritional coaching, and dermatology care. Looking ahead, respondents said they were most likely to expand access in these areas, as well as begin leveraging virtual care for sexual health, pre- and post-surgical monitoring and chronic care. In addition, health plans see comprehensive virtual care as a valuable tool to augment care management strategy in high-cost, highly complex cases, including those with behavioral health components, chronic pain, gastrointestinal complications, cancer and more. This focus will help guide members towards lower-cost care settings and therapies.

Demonstrable value. Intuitively, health plans recognize the potential ROI of virtual care. Virtual visits are more cost effective in most cases, clearly more convenient for the patient, and can drive greater resource efficiency on the provider side as well (no more wasted time slots!). The beauty of comprehensive virtual care is that it delivers a trifecta of value:

  • Offers members greater convenience and easier access to quality care;

  • Grants providers the opportunity to optimize in-person patient encounters, improve care coordination and effectively expand their networks; and

  • Drives down costs for health plans by increasing success with value-based care and directing member utilization appropriately.

To learn more about virtual care trends, please attend AHIP’s webinar: Virtual Care takes Center Stage for Health Plans at 1 p.m. ET, Feb. 7, presenting additional AHIP survey findings specific to Medicare Advantage and Medicaid Managed Care plans.