Telehealth's boom amid the COVID-19 pandemic has served as a stepping stone for "virtual-first" health plans, a model that promotes telehealth as the first touchpoint in the care delivery process.
While such plans involve both digital and in-person care, the virtual-first approach promotes telehealth as the first entry point to getting medical care, guiding patients to in-person care when necessary.
In recent months, some of the nation's largest payers, including Aetna, Cigna and UnitedHealthcare, have launched virtual-first options for employers or announced plans to do so, touting them as plans that provide convenient, lower-cost care.
To better gauge whether these plans will stick, Becker's spoke to two early adopters of virtual-first models about potential savings and how these plans may evolve.
The current virtual first landscape
UnitedHealthcare is launching NavigateNow — its first virtual-first health plan — later this year, said Will Shanley, a spokesperson for the payer.
The plan offers lower premiums for employers and lower member costs.
"Eligible employers can reduce premiums by approximately 15 percent compared to traditional plans, while members have $0 copays for virtual and in-person primary care and behavioral health visits, plus virtual urgent care, with unlimited chat, online scheduling and on-demand, same-day appointments," Mr. Shanley told Becker's.
The plan also features financial incentives for members, including a wearable device wellness program that promotes daily activity and allows participants to earn more than $1,000 per year.
Other payers — including Aetna and Trustmark Health — have collaborated with virtual primary care providers to develop virtual-first approaches.
Kelly Bliss, Teladoc president of U.S. group health, said that, in the plans it supports, the combination of benefit structures and the populations that enroll in the plan can deliver significant savings.
"We estimate that plan sponsors can see savings up to 10 percent when they partner with a company to create a virtual plan," Ms. Bliss said.
Measuring success
When it comes to tracking virtual plans, Ms. Bliss is focused on three metrics: cost, access and experience.
Without exception, she said a successful virtual plan needs to reduce costs for members and expand access to care. Virtual primary care consistently delivers in these two spaces.
Success in these two areas is simultaneously tied to member experiences, which Teladoc also has been tracking. This metric is critical, Ms. Bliss said, as she believes strong, positive experiences are key to members adhering to plans.
So far, the numbers support that thesis.
"In looking at our results to date, we've seen marked improvements in the member experience, Net Promoter Score, members following clinician recommendations and ultimately, members following up on their specific care plans," Ms. Bliss said. "This drives quality improvements and savings that are accrued from the preventive nature of primary care, and enhanced by our full suite of services."
In addition to cost, access and experience, Mr. Shanley said UnitedHealthcare will monitor reenrollment rates, how often members consistently utilize primary care providers and broad health outcomes.
Virtual-first plans' future
As payers evolve their digital approaches and prepare for the launch of virtual-first plans in 2022, their eyes are on transformation, innovation and expansion.
Mr. Shanley said that while NavigateNow is available to employers in nine markets, the insurer already has plans to reach over 25 markets and self-funded health plans by 2023. By then, he expects virtual first plans to already look different.
"We anticipate virtual-first plans to continue to evolve during the coming years, with a greater focus on using data and technology, including wearables, to help prevent disease before it starts and help individuals better manage chronic conditions, if needed," he said.
Ms. Bliss said the development in virtual health plans over the past 18 months is only the tip of the iceberg. In fact, she believes virtual-first plans are on track to be the new norm for members.
"We will no longer be talking about 'virtual-first' health plans, but will understand that all health plans should evolve and virtual delivery will be an expected element of the care delivery experience," Ms. Bliss said. "The type of care coordination and clinical navigation assistance provided by these plans will be commonplace in benefit designs across the board."