Insurers and virtual-first plans

Health insurers are looking to the massive expansion of telehealth brought on by the COVID-19 pandemic in creating new plans for patients.

According to a report from Kaiser Health News, some of the biggest names in health insurance are getting in on the action offering plans which see beneficiaries encouraged to choose an online doctor which acts as their first point of contact for most primary care and can make referrals for in-person care.

Many insurers offering these plans have hired outside firms to provide physicians who may hold licenses in several states and not located near the patients. Patient information is passed to the physicians through either the insurers internal EHR system or that of the third-party provider leading to questions of how health information could be passed from out of network hospitals or physicians, the report says.

Kaiser Health News likens the new programs to “HMO 2.0,” noting that skeptics have raised concerns about the need for primary care visits to be held in person due to the need to collect vital health information. Some insurers have provided patient with personal health devices to collect this information.

The latest insurer to step into the space is UnitedHealthcare. According to a news release, the company is launching a new virtual first plan called NavigateNOW. The plan is touted as offering beneficiaries 24/7 access to care through Optum for a premium 15 percent cheaper than traditional benefit plans.

“Patients want more options for getting care that is convenient for them and their lives,” said Kristi Henderson, Optum senior vice president for virtual transformation, and CEO of Optum Virtual Care, which includes Optum’s national virtual-first medical group. “Our work with UnitedHealthcare is designed to help make it simpler for patients and members to interact with their care providers by bringing together our virtual resources and national clinical footprint to provide a more seamless, connected experience.”

Telehealth boom

None of these programs would be possible without the seismic shift in healthcare toward telehealth, necessitated by the COVID-19 pandemic.

As previously reported, 36 percent of patients have accessed telehealth services during the past year, up from just 9 percent in 2020 and 7 percent in 2019. Usage is consistent across all generational groups, with the highest usage among members of Generation Y and Pre-Boomers. The top reasons for telehealth utilization are convenience (57 percent), ability to receive care quickly (47 percent), and safety (36 percent).

While it has seen a boom, patients’ patience with telehealth seems to be waning as overall satisfaction with both direct-to-consumer and payer-sponsored telehealth services declined in 2021 from 2020. The most frequently cited barriers encountered by patients are limited services (24 percent), lack of awareness of costs (15 percent), confusing technology requirements (15 percent), and lack of information about providers (15 percent).

Overall satisfaction is 85 points lower (on a 1,000-point scale) among patients with the lowest self-reported health status than among patients who consider themselves to be in excellent health. Similarly, healthier patients are more likely than less healthy patients to understand the information provided during the visit, say they receive clear explanations, perceive that their visits are highly personalized, and obtain high-quality diagnoses.

This article was originally posted on Medical Economics®.