As virtual care continues to gain acceptance and evolve from just providing episodic care, several health insurers have introduced virtual-first health insurance plans that offer primary, behavioral and sometimes specialty care via telehealth as they aim to improve access and affordability.
“Our system is broken. We need to try new things to fix it,” says Nina Birnbaum, M.D., medical director of innovation acceleration at Blue Shield of California, which recently launched a virtual-first health plan.
“It’s an exciting time because of the opportunity to bring disruption and innovation,” says Ashley Yeats, M.D., vice president of medical operations at Blue Cross Blue Shield of Massachusetts, which launched a digital-first health plan this year.
While virtual care for situations such as minor emergencies has been around for years, the COVID-19 pandemic “brought virtual care to the forefront,” says Santiago Doria, a principal at Oliver Wyman consultancy. “It increased consumer awareness and increased provider comfort.” During the COVID-19 public health emergency, the Centers for Medicare and Medicaid Services put into place regulatory flexibilities for Medicare members around telehealth and has allowed payment for an expanding list of care options delivered virtually.
A report by the Department of Health and Human Services says that as the start of the pandemic curtailed in-person access to healthcare, the use of telehealth soared from less than 1% of visits to as much as 80% of visits in locations that were hard hit by COVID-19. Although usage has dropped as the pandemic has waned, a Centers for Disease Control and Prevention survey found that 37% of adults had used telemedicine in 2021.
Access to in-person care has opened back up, but patients may wait 20 to 30 days to see a primary care physician, which is “just unacceptable,” Doria says. In contrast, some virtual primary care providers are offering appointments in one to three days, Doria says.
The lack of primary care access has led to increased reliance on urgent care and even costly emergency room care, Yeats says.
Elevance Health offerings
A number of Elevance Health-affiliated insurers, including Anthem Blue Cross in California, Anthem Blue Cross and Blue Shield in Georgia and Anthem Blue Cross and Blue Shield in Missouri, have recently started selling virtual-first plans. (Anthem changed its name to Elevance Health in 2022 but many of the affiliates are still using “Anthem” in their name.)
“Virtual-first plans align with the more consumer-centric experiences people are accustomed to in other areas of their lives,” says Morgan Kendrick, executive vice president of commercial plans for Elevance Health. “We expect to see utilization from people who might otherwise avoid care.”
The Elevance Health affiliates are offering plans that include routine wellness care, chronic condition management and behavioral healthcare. The plans have various cost-sharing options such as no coinsurance for virtual care. Members can also receive in-person care.
Elevance Health commissioned a Harris poll on virtual primary care last year that found about one-third of consumers had used virtual primary care and almost 95% of those who had used it said they were satisfied with the experience. About 80% said it helped them take charge of their health. Those with chronic conditions were more likely to have used virtual primary care.
Meanwhile, a survey by Rock Health and the Stanford Center of Digital Health found that 80% of those surveyed had used telehealth for any kind of care. Telehealth usage increased most among a number of groups, such as women, people age 55 and older, Hispanic individuals, those living in rural areas and people who did not have health insurance. More than 60% of respondents said they preferred it for prescription refills, more than half preferred it for treatment of minor illnesses, 38% said they preferred it for behavioral healthcare and 35% said it was their preference for help with managing chronic conditions.
The California version
Blue Shield of California launched its Virtual Blue plan this spring, working with Accolade, which providesprimary care services, and TeleMed2U, which provides specialty care, including behavioral healthcare services.
Consumers pay no copayment or deductible for virtual primary care, behavioral care or 20 kinds of specialty care. They can have an in-person visit with a physician, but copays and deductibles apply. Accolade has staff and contract physicians who work with health coaches, care coordinators and nurses, who help patients manage their chronic conditions, and they also coordinate in-person and specialty care.
The plan also puts an emphasis on patient diversity, and Virtual Blue members can select an Accolade physician based on factors such as gender, race and language. About 40% of Accolade physicians are people of color. The physicians share electronic health records, and Blue Shield of California has found that the providers interact and message each other, Birnbaum says, rather than operating in the usual way, in silos. “That’s really powerful.”
Because patients aren’t just receiving episodic care, they can “develop a relationship with a doctor over time,” she says. “It’s true longitudinal primary care.”
Switching back to in-person care
Blue Cross Blue Shield of Massachusetts began offering a virtual-first plan with primary and behavioral health care this year, teaming up with providers Carbon Health and Firefly Health.
Members can choose their primary care provider, with no cost sharing, and have access to in-person care as needed. The goal is to increase access while improving quality, Yeats says.
The providers offer chronic disease management that “really wraps the care team around the patient,” he says. The insurers say including behavioral healthcare in their plans is crucial. “Behavioral health and access to it is one of the most pressing concerns of our day, and we offer solutions that allow for convenient care,” Kendrick says.
For employers, virtual-first plans may be especially appealing, Kendrick says, as they look for “sustainable, flexible, customizable plans in the midst of the highest projected increase in global medical costs in nearly 15 years.”
Allowing members to choose the primary care option that works best for them is also crucial, Yeats says. At Blue Cross Blue Shield of Massachusetts, members aren’t locked into a particular care delivery model. If virtual care isn’t to their liking, they can switch to in-person care, Yeats says.
“Understanding how the needs of members can be uniquely met is critical,” says Melinda Durr, principal with EY-Parthenon consultancy. “It’s not one size fits all.”
Doria says some payers are partnering with providers such as Accolade and Firefly because of their expertise with virtual care. “A provider on video isn’t enough. You need new workflows and ways to interact” with patients. “You can’t just put a digital front door on an existing health plan,” Durr adds. Providers need to be successful in engaging with patients.
Durr expects the virtual-first model to evolve. “The first time we do this is not going to be right.” Although virtual-first health plans may currently be the exception rather than the rule, Birnbaum says, “I think this is just the way care is going to be.”
Susan Ladika is an independent journalist in Tampa, Florida, who covers business and healthcare and is a regular contributor to Managed Healthcare Executive.