Predictions in an Evolving Health Care Landscape and the Significance of Virtual Care
Virtual care brings change amid cost pressures and rising primary care needs
As the US continues to combat rising health care costs, support for virtual care is growing among both industry stakeholders and policymakers. During a recent webinar, Matt Eyles, president and CEO of AHIP, and Kelly Bliss, president of US Group Health at Teladoc Health, discussed the “perfect storm” of factors propelling new care delivery models into the spotlight as vehicles for change.
Looming economic pressures
Today’s health care organizations face considerable financial pressure as they transition to value-based care models, said Eyles. Health care costs are expected to rise about 5.4% this year, which is a significant jump from 2022, and affordability is top of mind for people.
The good news is that virtual care relieves some of this pressure, particularly as the fear of a potential recession continues to grow, Eyles added. “We know that telehealth has played a critically important role in terms of delivering quality results for our members.”
Uptick in the need for primary care
Health care organizations continue to recognize the need for primary care as a gateway to preventive services and management of chronic diseases. However, access is a challenge in many areas of the country, prompting providers, employers and health plans to explore or expand virtual care delivery models, Eyles said.
Additionally, once the public health emergency ends on May 11, 2023, Medicaid redeterminations could leave as many as 14 million people without insurance coverage.(1) “One of AHIP’s major goals this year is to make sure as many people stay covered as possible as we transition out of the [public health emergency],” said Eyles. “Innovation in virtual primary care will be very important.”
For example, Primary360, a virtual primary care solution offered by Teladoc Health, helps reduce avoidable health care costs by providing better access to primary care, said Bliss. According to Teladoc Health data, 60% of members using Primary360 had not previously seen a primary care physician in the past two years.
Bliss noted that the midyear shift of patients from Medicaid to Affordable Care Act plans may also have an impact on risk adjustment. “You need to get those diagnoses captured within the calendar year, and if a patient joins midyear, providers may struggle with this, especially considering how long it could take to get an appointment,” Bliss said. “We’re seeing a tremendous use case around providing virtual care access to these members who may have PCP disruption.”
Connecting patients with primary care enables earlier disease detection: Teladoc Health data show 38% of members using Primary360 were newly diagnosed with diabetes, and 26% were newly diagnosed with hypertension.
Meanwhile, Americans continue to value the convenience and simplicity of telehealth, making it an ideal time to integrate virtual care. Nearly 3 out of every 4 commercial telehealth users said Congress should make permanent provisions allowing for telehealth coverage prior to meeting the deductible, according to a recent AHIP survey.(2)
Now that virtual care-related outcomes data are readily available, hospitals, health systems, employers and health plans have shifted their attention to value. In particular, they’re asking these questions:
Are the outcomes worth the price?
Does the solution close care gaps and address quality?
Does the virtual care solution accelerate improvements in certain populations?
Bliss said solutions deployed over the past two years will be “pressure tested” to determine whether they’re truly effective at fulfilling the promise of value-based care.
Virtual care solution providers will also continue to focus on patient safety. “We’re hyper- focused on exceptional, evidence-based care in primary care, chronic care and mental health,” said Bliss, noting that Teladoc Health founded the health care industry’s first Patient Safety Organization (PSO) dedicated to virtual care.
Bliss and Eyles agreed that in the years ahead, the US health care industry will likely see a decline in the number of digital health point solutions as integration becomes paramount. Fifty-three percent of large employers cite better integration as a top focus area.(3)
“As health care leaders, I think we squander the real opportunity to really move the needle on cost of care if you only consider a ‘one problem, one solution for one population’ approach,” said Bliss. “Many times, it’s little or no incremental cost to add a solution to the integrated platform, and you create administrative cost synergies, natural patient engagement lift and a modernized health care experience where you can leverage data to personalize patient care.”
Eyles agreed that employers want integrated data that looks across the entire patient care continuum so they can promote whole-person care. Health plans that can provide this will set themselves apart as providers of the best, most cost-effective care at the greatest convenience for members.
1. Tolbert, J., Ammula, M. 10 things toknow about the unwinding of the Medicaid continuous enrollment provision. KFF. Feb. 22, 2023. https://www.kff.org/ medicaid/issue-brief/10-things-to-know- about-the-unwinding-of-the-medicaid- continuous-enrollment-provision/
2. Survey of telehealth use by commercial insurance enrollees. AHIP. Dec. 1, 2022. https://www.ahip.org/resources/survey- of-telehealth-use-by-commercial- insurance-enrollees
3. 2023 large employers’ health care strategy and plan design survey. Business Group on Health. Aug. 23, 2022. https:// www.businessgrouphealth.org/%20 resources/2023-large-employers-health- care-strategy-survey-intro