With the launch this spring of a nationwide telemedicine-provider network, the country's largest commercial health insurer is set to offer coverage for virtual doctor visits to 20 million beneficiaries by next year.
Telemedicine is ready for takeoff, and UnitedHealth Group is banking on it.
The commercial payer Goliath, which provides healthcare benefits coverage for more than 40 million people through the company's UnitedHealthcare division, recently announced an ambitious initiative to offer coverage for telemedicine doctor visits in 47 states and the District of Columbia.
Karen Scott, senior director for product and innovation at UnitedHealthcare, says the initiative is designed to help elevate telemedicine to the mainstream of healthcare delivery options. "Choice and access are key components of our strategy," Scott told me last week. "Our strategy is to build a robust model and infrastructure comprised of multiple provider groups, which enables us to support many types of virtual visits across the country."
UnitedHealthcare's strategy is slated to unfold over the next two years.
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"With this new initiative, virtual visits are covered as an in-network benefit, and are available to self-funded customers in 2015; rolling out to fully insured and individual members in 2016," Scott told me. "We see the greatest demand among our self-funded employer groups… We can quickly enter the market and offer the benefit to a significant number of members. In 2015, 1 million members will have access to virtual visits as a covered benefit. In 2016, an additional 20 million commercial members will have access to the virtual visit network."
The potential for eye-popping growth in UnitedHealthcare's new telemedicine business line reflects rapid expansion of telemedicine service offerings across the country. Last year, 12 million Americans were served in some form through telemedicine technology, and that number is expected to double this year, according to the American Telemedicine Association.
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The backbone of UnitedHealthcare's "virtual visit network" is a trio of telemedicine service providers: Boston-based American Well; San Francisco-based Doctor on Demand; and Now Clinic, a telemedicine platform developed at American Well and marketed at Optum, which is another division of UnitedHealth Group. Pooling telemedicine providers is enabling UnitedHealthcare to offer coverage for virtual doctor visits in every state except Alaska, Arkansas, and Louisiana.
The president and CEO of American Well Systems, Roy Schoenberg, MD, MPH, says the UnitedHealthcare telemedicine initiative has a "huge footprint."
"We don't want to force anyone into specific services," Schoenberg told me this week. In states served by multiple members of the televisit trio, he says American Well, Doctor on Demand, and Optum are content to let UnitedHealthcare beneficiaries pick their favored telemedicine provider. "The membership can decide which telehealth services to go for."
Telemedicine as Care Setting
UnitedHealthcare's telemedicine initiative is just scratching the surface of a burgeoning market, he says. "They're looking for telehealth to grow… beyond a quick CPAC prescription to one of the ways you get care from your doctor. What we've seen so far is the first generation of telehealth, mostly quick solutions for patients. What we're now seeing is the arrival of the second generation— catering to the much bigger chunk of healthcare in management of chronic illnesses—conditions like cancer, and behavioral health."
Roy Schoenberg, MD, MPH |
That second generation of telemedicine will be focused on providers, Schoenberg says. "For telemedicine to become a care setting, we have to give just as much attention to the healthcare provider as the healthcare patient. We need to be equipping providers with technologies to make telehealth part of the way they treat patients."
Shifting the Financial Risk
The accelerated adoption of value-based payment models in the healthcare industry has emerged as a potent prompt for providers to embrace telemedicine. Schoenberg says that accountable care contracting and other value-based payment models are "shifting the financial risk to provider organizations," and that telemedicine is a powerful tool to help manage that risk.
"That transition is giving a clear message to the provider side: You need to find a better way to monitor and envelop patients. The delivery side of healthcare has realized that they have to start equipping themselves with technology to stay closer with their patients. Health systems now view telehealth as an imperative."
Payers have a crucial role to play in supporting provider adoption of telemedicine services, Schoenberg says. "Payers, historically, have needed to offer telehealth services because of their undeniable convenience. This year, health plans are starting to invest in bringing telehealth into their own provider networks."
In recognition that most health plan dollars are spent on treatment of chronic disease, he says payers are asking themselves a multibillion-dollar question: "How can we equip our physicians to treat their chronic disease patients more effectively?"
One of the answers to that question is telemedicine, Schoenberg says. "You can literally equip providers with technologies so they can care for their patients in a modern way. You can convert conversations from email and telephone exchanges into well-documented telehealth visits. The health plans have a huge role to play. It's all about payers working with providers to get telehealth technology into their hands."
UnitedHealthcare is banking on telemedicine, and it would be wise not to bet against them. Last year, its insurance division generated $120 billion in revenue, showing that its executives know a thing or two about banking.
Apple Inc., one of the largest corporations in the world, also is bullish on telemedicine, Schoenberg says. "We have had a long collaboration with Apple. Telehealth is more transformative than most people think. That company is putting telehealth in its sights."
He says there is a cartoon-like quality to the pace of telemedicine growth. "You start with a little wave, then you're 1,000 feet in the air. It's a thrilling, delightful and exciting experience."
Christopher Cheney is the CMO editor at HealthLeaders.