Virtual Care Expanding From Pandemic Necessity to Delivery System Innovation

"Expanding into virtual-first health plans is the next step in providing a convenient and comprehensive care experience," says one health plan executive.

A growing number of regional and national payers are putting telehealth at the center of their care delivery, benefit, and plan designs. With these developments, the virtual visits mothered from pandemic necessity could transform to permanent innovations built on the telehealth foundations that already existed. Implemented well, virtual health could solve multiple problems while paving the way for future virtual therapies that are smartly reimbursed from the start.

Telehealth as care delivery design

Under the care design category, CareFirst has introduced CloseKnit, a "virtual primary care" [model that] … will offer a wide variety of care services, including preventive and urgent care, behavioral and mental health, care coordination, insurance navigation and more." CareFirst will offer CloseKnit to its Maryland commercial enrollees to test this new model. The plan also offers plans in Maryland and the District of Columbia. Larger payers are also taking a pilot approach, while embedding telehealth even more deeply in benefit and plan design.

Telehealth as benefit and plan design

Aetna, Cigna, and UnitedHealth are three national providers announcing their telehealth developments as part of a broader, virtual care strategy. Aetna has called its Virtual Primary Care the "first nationwide virtual primary care solution," while Cigna and UnitedHealth offerings include "virtual-first" health plans. Aetna's Virtual Primary Care, Cigna's MDLive, and UnitedHealth's NavigateNOW all include virtual primary, behavioral, and urgent care, and in some cases dermatology.

Some rollouts are large-scale, others tiered. In contrast to Aetna's national Virtual Primary Care network, Cigna will offer its expanded MDLive services to all employer-group members, with exchange plan members having access to virtual dermatology. This is in addition to a broader "virtual-first" plan option, also for select employers. The plan does not require referrals for in-person, in-network visits and includes $0 copays for "MDLIVE primary care providers, comprehensive chronic condition management and care navigation." UnitedHealth's NavigateNOW offers similar $0 copays and for select employers in nine markets.

Can virtual first deliver on accessible, primary care promises?

In its announcement, CareFirst President and CEO Brian D. Pieninck notes that "[n]early 40% of our members don't have a primary care doctor" and that "CloseKnit helps fill critical gaps for many patients, particularly those who lack a PCP." This raises the question: Can virtual first help achieve what every other coordination model—from HMOs to medical homes to value-based contracting—are often still struggling to produce: cost-effective services rooted in primary care that create better outcomes?

Making convenience a reimbursable commodity rather than "a nice to have" may be the missing ingredient. Along these lines, Pieninck adds: "We created CloseKnit because people deserve an enhanced, modern care experience that meets their expectations, needs and preferences for choice in how they connect and experience care."

Post-pandemic staying power?

What began as a solution for patients in rural areas with limited access to providers could have much broader applications for decades to come. This is particularly true now that commercial telehealth is growing and with the Centers for Medicare & Medicaid Servicers (CMS) permanently expanding telehealth's definition and scope.

And there could be a wraparound effect. Well before the pandemic, consumers were already turning to apps and wearables to put better health at their fingertips. Well after COVID-19 is no longer a public health emergency, it's likely that more prescription digital therapeutics will be reimbursed, ideally via value-based contacts from the start.

Current-state virtual care emerged from unanticipated, systemic disruption that could create planned and permanent systemic innovation. This is not to say that payer and provider virtual capabilities were in 2019 what they are in 2021. Email and text communication, however automated, is not remote monitoring. The question continues to be: Why does it take a crisis to not only drive change but fully implement and reimburse existing solutions?