Positioning Virtual Care to Transform Health Benefits 

Mother multi-tasking with infant daughter in home office
Jun 04 2020

For years, analysts have been predicting the shift toward virtual care, but it was COVID-19 that brought rapid acceleration to the space. While the pandemic has created immense public health challenges, it has also has revealed significant opportunity for employers to transform the role of virtual care and make it central to future benefit strategies.

Since the pandemic began, we’ve seen unprecedented growth in people using telemedicine services like Teladoc and MDLive. According to Mercer’s National Survey of Employer-Sponsored Health Plans, 88% of employers had a telemedicine program in 2019 but only 22% had utilization greater than 10%. In the early weeks of the pandemic, employers promoted the use of telemedicine both to triage CV-19 symptoms and as an alternative to in-person visits that would reduce exposure risks. FAIR Health's Monthly Telehealth Regional Tracker reports that telemedicine utilization actually grew by more than 4,000% year-over-year in March. And early results from an ongoing Mercer survey show employers reporting high levels of satisfaction with their telemedicine program in terms of response time and member service during the pandemic, with 41% satisfied and 27% very satisfied.

Outside of telemedicine programs, virtual visits between patients and their own doctors has also taken off. Congressional action relaxed security standards and temporarily allowed Medicare reimbursement for virtual visits. HHS even sent instruction kits to providers to help them get set up for virtual visits. As a result, growing numbers of physicians who had never practiced via any form of telehealth technology are now seeing patients virtually every day. And to make this a perfect storm – the good kind -- digital health solutions and telehealth technologies are the fastest-growing areas for investment Healthcare Smart Money VC investors. 

This rapid change in health care delivery has created the opportunity to dramatically transform the way we access care in a very meaningful way for patients, providers and payers. But it is up to us to make sure that all goals are aligned properly. Here are some considerations as you start to plan for your health program’s virtual care transformation:

  • The new front door to care. Think of digital health tools powered by artificial intelligence (AI) as the new way to enable consumers to conveniently and efficiently navigate to the right care and the right modality -- whether it is primary care, a smoking cessation program or a virtual counseling session. What role do digital tools play in your benefits plan design today? Do they offer the delightful user experience often seen in consumer applications?
  • Virtual care as the new foundation to rebuild primary care. Consider the fact that 26% of Americans do not have a primary care physician -- and that the number goes up to 45% for millennials. Convenience could be a game-changer to support engagement with a primary care provider, which in turn supports early identification of health issues and care continuity.
  • Right-sized reimbursement will dictate the virtual care economy. Currently, most virtual visits with medical plan network providers are reimbursed at the in-person visit price. While that may be justified during the height of the pandemic, ultimately pricing needs to be aligned with the efficiencies of virtual care or it will break the bank for employers and employees.
  • Design for new options with the triple aim in mind. Convenience could drive more utilization. Is more utilization good? Plan design will need to promote efficient, appropriate utilization with incentives that drive quality and value.
  • Keep an eye on public policy: There is a lot of activity to extend Medicare reimbursement for virtual care beyond the pandemic (which is a good thing). Keep an eye on proposals that may mandate reimbursement policies for virtual care and telemedicine beyond Medicare and have a direct impact on the efficiencies of employer virtual care strategies.
  • The holy grail? Digital health tools and telehealth technologies could be the path to a consumer-grade experience that engages users to improve compliance and adherence.
  • Are there savings to be had? We think so. Importantly, there is a real opportunity to improve health care affordability for consumers as well as generate savings for plan sponsors. But that will require employers to actively manage their organization’s digital strategy -- or be at the mercy of the market.   

This is only the beginning. Mercer will continue to track the momentum in this space and do our part to ensure that this transformation is beneficial to employers and employees nationwide. Stay tuned!

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