There’s no need to describe the epic surge in the use of telemedicine since March – we’ve all witnessed it first-hand. It’s time to start talking about the next steps. For employers, leveraging telemedicine and other types of virtual care will require thoughtful strategies.
On the one hand, plan sponsors are encouraged that telemedicine utilization has increased more in a few months than they expected it to grow in five years. They recognize the value of primary care and behavioral healthcare, and see telemedicine as an important means of increasing access particularly for those in underserved communities. But at the same time, they are concerned that decisions being made now, under the pressure of the pandemic, may have unintended consequences for the future of healthcare.
There is no turning back the clock. Having been steered to virtual healthcare during the pandemic, health plan members now expect virtual visits will continue to be available – and their expectations only are being reinforced by the ongoing shift to more virtual modes of working and conducting business. Health systems are already working to realize the potential of virtual care. “Hospital at home” is one of the ways hospitals created capacity during COVID, Mayo Clinic has announced an at-home advanced care model, and E-consults – doctor to doctor consultations – are already used to support specialties and address deficiencies in care access in some areas of the country. Visionary plan sponsors, health plans and provider organizations see virtual care as the next wave in healthcare. They see a hybrid model – more virtual care, balanced with the appropriate level of in-person care – leading to better outcomes and lower healthcare costs, and thus greater value for both the plan sponsor and plan members.
As the new care delivery models take hold, we have begun to grapple with how we pay for them. Telemedicine visits and other types of digital and virtual interactions may not be ideally suited for fee-for-service arrangements when you consider the actual cost to provide the care compared to the cost to document and bill the encounter. These services may be better aligned with value-based care arrangements, as a means to support an established patient. But it’s clear that for the vision of virtual healthcare to become a reality, we will need to right-size reimbursement and ensure equitable payment for the intensity of the service provided.
The greater ease and convenience of virtual care – for both the provider and patient – make it likely that virtual visits will not substitute for some in-person visits on a one-to-one basis, but rather that the combined number of virtual and in-person visits will increase. If, after the pandemic eases, virtual visits continue to be billed at the same rate as in-person visits, not only will we fail to realize savings from virtual care, but total healthcare spending will rise. We also may need to consider if all telemedicine visits are necessary. There may be a role for AI triage to screen symptoms and direct a patient to a care access point or to self-care. These types of solutions are already available (examples include Buoy Health and 98point6) and have played an important role in return-to-the-workplace efforts.
It’s time for employers to get involved. You can:
- Closely scrutinize the reimbursement for telemedicine services. We are seeing the cost of the traditional telemedicine visits increase, and some vendors are expanding from providing acute, episodic care to primary care models. If you’ve been notified of a cost increase, make sure you understand what you’re getting for the extra money. In addition, some carriers continue to reimburse virtual office visits with network providers at the office visit level – you may want to question that as well. In our data warehouse, we’re seeing reimbursements for telemedicine visits of about $40 for traditional carve-out plans but about $120 for network physicians.
- Align your plan design with your utilization objectives. Does your plan design make it easy for your employees and their dependents to do the right thing when it comes to seeking care? As comfort with telemedicine increases, so will utilization. Just as virtual visits can replace some office visits, healthcare AI can replace some virtual visits. It may be time to re-think your plan design.
Virtual care can play a vital role in expanding primary care access and building a stronger, more resilient healthcare system – but only if all stakeholders treat it as a means to drive greater efficiency and value.