Virtual-first health plans: Keeping patients connected between telehealth visits

Prior to the COVID-19 pandemic, trends showed increased interest in the use of telehealth services by healthcare professionals and patients.

While it was already widely believed by industry analysts that telehealth would eventually become integral to our healthcare system, COVID-19 has thrust it into the forefront almost overnight. As Fair Health's monthly telehealth tracker shows, telehealth claim lines increased more than 3,550% from August 2019 to August 2020, growing from about 0.2% of all medical claim lines to about 6.1%.

Health insurance companies, recognizing the growing consumer demand for and possible cost savings associated with telehealth, are launching what are being described as "virtual-first" health plans. These plans leverage telemedicine technology to provide insured patients with quick access to primary care clinical staff. The new health insurance offerings are ideal for providers and consumers alike in the current health climate. The success or failure of this first group of pioneering plans will determine the general acceptance of the concept with consumers, employers, and regulators. In addition, the implementation and choice of health technology utilized will be a major factor in determining whether virtual-first plans are successful.

What is virtual-first health insurance?
Quite simply, virtual-first health insurance makes telemedicine a foundational part of the patient's care. It's essentially used as a digital "front door" that permits patients to quickly and easily access virtual healthcare services that then guide them to in-person care, when needed. If virtual-health plans achieve their objectives, the end results should be more frequent, improved access to care that also lowers costs, among many other benefits.

Both newer, tech-focused health insurers and venerable, traditional insurers have turned their attention to the virtual-first model. Two of the largest new health plans with a virtual-first model are being offered by Oscar and Kaiser Permanente.

Oscar recently rolled out its "Virtual Primary Care" in Dallas and Houston and has announced its intent to significantly expand the offering in 2021 to 19 new markets. Oscar's virtual-first plans include access to designated virtual primary and urgent providers; zero-dollar and unlimited virtual visits with Oscar primary care providers, and initial specialist referrals prescribed by Oscar primary care providers. In addition, Oscar's plan offers no-cost "Virtual Urgent Care," which provides 24/7 access to Oscar urgent care providers.

In September, Kaiser announced that it was launching "Virtual Plus," the newest care plan offering from Kaiser Foundation Health Plan of Washington. The plan is scheduled to be available starting in 2021. Members enrolled can seek nonurgent services via phone, online chat, video, or email. Kaiser states that members in the plan will be seen by the same doctors and clinicians as they would at any Kaiser Permanente facility. Members will also have access to Kaiser Permanente pharmacists through an online or video visit and can have their medications delivered.

Telehealth and the success of virtual-first health plans
Although the virtual-first health plans announced thus far have generally embraced remote clinical services (i.e., telemedicine), their level of support and coverage for other aspects of telehealth varies widely from plan to plan. The virtual-first concept provides an opportunity for the integration of mobile health technologies with routine patient care. A comprehensive virtual-first platform should also include non-clinical services, such as, patient educational content, care plan support, medical records access, and remote services.

Even with the systemic benefits that expanded virtual clinical services can bring on their own, the real potential of the virtual-first concept is its ability to engage patients in their own health and wellness between virtual clinical visits. If executed effectively, this should have a profound impact on patient care. Care teams would gain greater ability to coordinate directly with patients and help make patients more active participants on their care team. Ongoing communications and interactions would ultimately strengthen patient engagement with and buy-in into defined health goals, maximizing patients' own efforts at staying healthy.

An espoused benefit of virtual-first is that it creates many smaller patient interactions with the healthcare system instead of patients only undergoing a single annual checkup (assuming the patient remembers and/or is reminded to schedule such an appointment) or visiting urgent/emergent care when they are sick. Adding other telehealth modes to fill in gaps between visits further increases engagement and clarifies patient status when an in-person visit incurs.

Remote patient monitoring and virtual-first plans
Remote patient monitoring (RPM), also described as "remote physiological monitoring," may be the most beneficial of the non-clinical remote services that health plans will want to consider integrating into their virtual-first offerings. Not only does RPM allow patients to take vitals measurements in preparation for virtual visits, but it can also be utilized as part of a care plan to show patients' progress in a more comprehensive way between visits. Given these benefits, it is not surprising that about half of the announced virtual-first plans launching in 2021 include some RPM coverage.

One of the strongest arguments against the virtual-first model is it will lower the number of in-person visits where patients undergo critical checks of their vitals and other physiological measurements. Without these reviews, providers would seem to lose some ability to achieve timely detection and management of chronic conditions, adjust medication regimens, and other actions that can improve health and reduce costs, including expenses associated with the need for and usage of healthcare services.

A potential workaround to the decreased frequency of in-person physiological measurement checks is tasking patients with self-reporting their vitals and other measurements. But such self-reporting programs have historically experienced patient compliance problems. Contributing factors include patients underreporting issues in an attempt to minimize their problems, exaggerating issues to make their situation seem worse, forgetting to report their vitals data, or making mistakes when reporting data. Although these issues can be mitigated in a traditional setting, data reliability is particularly important in the virtual-first scenario as providers lack the periodic clinically measured vital measurements needed to guide treatment decisions and care planning.

Remote patient monitoring solves these problems as it essentially eliminates the "self" component of self-reporting. The virtual-first model also lends itself well to the logistics of an RPM program. Depending on their risk profile, a patient can be sent an RPM device in their initial enrollment "welcome kit" or as determined by their care staff during virtual visits. Given that technology — and often a patient app — is already central to the patient virtual experience, normal barriers to RPM utilization like device training and configuration are largely pre-mitigated.

Further, patient education can be made available and delivered to patients automatically, given changes in their collected vital measurements, and then discussed during virtual consultations. This melding of immediate patient feedback and clinician follow-up can increase patient engagement while also reducing overall costs. Remote monitoring programs in other contexts have shown many benefits that would also be applicable to virtual-first plans, including:

• helping patients be more active participants in their care, which, as previously discussed, has its own proven benefits;
• reducing hospitalizations, readmissions, and lengths of hospital stays;
• increasing patient engagement and education through mobile health applications; and
• increasing collaboration and coordination between patients, providers, and their care staff.

Non-clinical telehealth services: An under-tapped opportunity
There are several factors contributing to the monumental surge in telehealth adoption. These include policy changes during the pandemic that have reduced barriers to telehealth access and promoted the use of telehealth, efforts by consumers to limit in-person contact with others as a means to reduce their risk of exposure to the novel coronavirus, professional medical societies endorsing and providing guidance concerning telehealth services, and companies offering services and solutions to support the delivery of virtual primary, specialty, acute, and chronic care.

Non-clinical services such as automated patient education systems, remote patient monitoring, and care management applications are an important aspect of telehealth that have yet to be fully leveraged, but a large window of opportunity exists for health plans with virtual-first offerings. Consumers not only now know more about telehealth than ever, but most are comfortable with using technology. A Healthgrades consumer survey revealed that, "At least 83% of consumers agree that telehealth can replace some or all of their in-person appointments and are open to interacting with their healthcare provider virtually." In addition, the current pandemic has given many consumers an introduction to the convenience of telehealth, creating a heightened demand for virtual services that is pushing private industry and public regulators to expand acceptance, coverage, and availability.

A McKinsey & Co. report highlights the potential for telehealth to transform the delivery of care, stating that "… up to $250 billion of current U.S. healthcare spend could potentially be virtualized." This figure is not surprising when you consider 76% of consumers surveyed in May by the consulting firm expressed interest in using telehealth going forward — a figure that's up from just 11% in 2019.

For health plans hoping to add consumers looking for offerings that will allow them to take advantage of telehealth's many benefits, non-clinical telehealth services that incorporate patient vital monitoring, automated health education, and patient engagement are likely to be a differentiator that may eventually become an expectation.

Daniel Tashnek is the founder of Prevounce Health. Prevounce is a cloud-based platform that supports organizations in their delivery of remote patient monitoring services as well as chronic care management, annual wellness visits, and preventive services.

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