MedCity Influencers, Hospitals

Developing value-based virtual partnerships: What health plans should know

Given the growing interest specialty providers are showing in virtual visits, health plans should ensure that their telehealth offerings include consumer access to a wide breadth of specialists.

If there’s a silver lining to the Covid-19 pandemic, it’s the spotlight it has put on the role of value-based, virtual health care models to address issues such as access to specialists, healthcare speed and efficiency, and healthcare inequities.

Indeed, approximately 75 percent of employers in a recent survey said they plan to ramp up their implementation of value-based care models over the next three years, with many indicating they are exploring virtual care partnerships to, among other goals:

  • Match members with experts best suited to their medical needs—and not just locally;
  • Deliver faster, more efficient care, along with improved patient experiences; and
  • Reduce disparities in care that affect ethnic and social minorities.

That employers are seeking such assistance makes it incumbent upon health plans to do more than simply offer virtual doctor visits as part of their benefits packages. The most successful plans will distinguish themselves by implementing three key strategies to develop successful, value-based, virtual partnerships with providers, employers and consumers.

Competitive plans will offer access to a wide breadth of specialists.

Given the growing interest specialty providers are showing in virtual visits, health plans should ensure that their telehealth offerings include consumer access to a wide breadth of specialists. This trend skyrocketed as the pandemic spread in 2020, with some specialists increasing the number of virtual visits from 20% to more than 90%, particularly among those with patient bases extending beyond U.S. borders.

Along with increased virtual specialist offerings, the market for second opinions in healthcare is also soaring, projected to reach $7 billion by 2024, up from $2.7 billion in 2017. According to one recent study, 28% of patients who receive a second opinion for life-altering diagnoses, such as cancer, receive a change in diagnosis. Moreover, 72% of treatment plans are modified after being reviewed by an expert. These figures underscore the importance of virtual access to global expertise when local expertise in rare or especially complex cases in emerging specialties such as gender-reassignment surgery, is in short supply.

Finally, competitive plans and providers will also make it a point to deliver virtual access to behavioral health care and experts. Acute behavioral health issues such as depression drive some of the greatest demand for medical care and its associated costs for health insurers; the pandemic has only served to heighten this demand. According to Deloitte, the share of people reporting negative behavioral health impacts from Covid-19 rose from 32% to 53% in the four-month period spanning March and July 2020.

As a result, payers and providers are devising innovative ways to address mental health needs virtually. One Florida hospital, for example, has begun leveraging virtual “telepsychiatry” services to reduce the burden on staff psychiatrists caring for inpatient and emergency department (ED) behavioral health patients. As a result, the hospital has reduced its average ED response time from 24+ hours to less than 30 minutes; decreased the average time for transfer out of the ED to less than four hours and conducts more than 220 telepsychiatry consults per month.

Competitive plans will deliver faster speed to insight and higher-quality member experiences.

In this still-nascent world of virtual healthcare delivery, the most competitive health plans and providers will make it their mission to increase speed and efficiency and improve the patient experience. This translates to reducing wait times for appointments, particularly with specialists; ensuring fast and easy access to second opinions; securing swift test scheduling—and equally fast results turnaround; and prompt follow-up consultations with providers.

To this end, plans must identify the answers to questions like these:

  • What tools do we need to make virtual care flexible and easy to use for members and physicians?
  • How quickly can we accommodate telehealth appointments—and what types of investments and workflows do we need to speed access to care?
  • What training do our physicians need to engage patients and provide an optimal virtual care experience?
  • What support do we need, especially on the front-end of the encounter, to promote speed to insight? 

Competitive plans will use virtual care to eliminate care disparities

The Covid-19 pandemic has notably revealed the healthcare inequities that persist among minorities and other underserved communities, which have been disproportionately impacted by the disease. Many living in rural or impoverished areas of the country, those with chronic conditions, and patients in the LGBTQ+ community do not have ready access to specialists. Health plans should focus on developing partnerships to provide the telehealth services required to meet the needs of these populations. At least one health plan, for example, is developing a program aimed at making it easier for the LBGTQ+ community to access specialists in transgender health and gender-identity surgery.


If any good has come out of the Coivid-19 pandemic, it is the significant role that value-based, virtual health care models can play in addressing such issues as access to care, healthcare speed and efficiency, and healthcare inequities.

Employers are increasingly seeking virtual care partnerships to help them achieve these goals, which can both reduce their own health coverage costs and help their employees obtain the level of care they expect and deserve.

Health plans that leverage telemedicine to offer access to a wider breadth of specialists, faster speed to insight accompanied by a higher-quality experience, and better solutions to eliminate disparities in care, will be in the best position to develop successful, value-based virtual partnerships with providers, employers and consumers.

Photo: Gerasimov174, Getty Images


Frank McGillin serves as the CEO of The Clinic by Cleveland Clinic. His leadership experience spans more than 20 years of general management, marketing, and innovation roles at Philips, Johnson & Johnson and digital health startups with expertise in launching and scaling innovative, global businesses at the intersection of healthcare and technology. Frank was most recently Chief Commercial Officer at NeuroMetrix, where he led the startup of a new digital health business and established partnerships with GlaxoSmithKline, CVS Health, and Best Buy. Frank held several General Management and senior leadership roles at Philips driving increased EBITA through innovation and organizational redesign. He led a global marketing transformation program for Philips Medical Systems, creating a new organization with a shared vision, strategies, and metrics. Frank is a graduate of Northeastern University and earned an MBA in Finance from Fordham University.

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