Consumer / Employer

Where Does the Industry Stand on Virtual-First Health Plans?

During a recent webinar, industry leaders agreed that virtual-first health plans have significant potential to cut costs and improve members’ experiences — if executed well. They also noted that employers are more willing than ever to adopt these types of plans.

A few years ago, the pandemic catalyzed a new era of “virtual-first” healthcare — which is often understood as a care delivery model in which providers use online platforms, telemedicine hubs and other digital tools to deliver medical services such as consultations, diagnoses and prescription refills.

A week ago, HLTH hosted a webinar in which leaders assessed the rise of virtual-first health plans. The panelists agreed that if executed well, virtual-first health plans have significant potential to cut costs and improve members’ experiences.

Firefly Health CEO Fay Rotenberg said she isn’t a big fan of the term “virtual-first.” Firefly, which sponsored the webinar, is a virtual primary care startup that launched its own health plan for employers in 2021.

“I think that [the term] has been very diluted through association with far more narrow solutions. I want it to mean that virtual becomes an ingredient in all care — seamlessly integrated. Right now, I think that people just don’t know what it means, and the industry as a whole hasn’t yet agreed on what the tenants of a virtual-first plan should be, aside from providing broad discounted access to virtual care as part of the plan design,” Rotenberg declared.

Virtual-first health plans should go beyond simply providing access to virtual care services — which, if done poorly, can actually drive up the total cost of care and result in a fragmented, frustrating member experience — she argued.

A virtual-first health plan should not look like an “archipelago of disconnected islands,” Rotenberg explained. In her view, it should be a bridge system bringing together all aspects of care and coverage.

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Ashley Yeats, vice president of medical operations at Blue Cross Blue Shield of Massachusetts, agreed with Rotenberg. He said he is excited by virtual-first plans’ potential to connect all the various stakeholders involved in a patient’s health journey — such as payers, pharmacists, dieticians, mental health providers, specialists, surgeons and primary care providers.

By having this big picture view of a member’s healthcare journey, virtual-first health plans can spot gaps in care and follow up with members to ensure they’re getting the services they need, Yeats noted.

“That follow up makes sure that the member understands what just happened in their visit and can connect the dots on getting prescriptions refilled and getting in-person care they might need,” he stated.

Rotenberg added that risk-bearing advanced primary care should be at the core of a virtual-first health plan, ideally free to the member. This ensures greater accountability and alignment in terms of quality and cost outcomes, she said. She also said that patients need primary care delivered through an easy-to-use digital platform that can easily guide them to any necessary in-person services.

“There should be an approach to in-person care services that involves a tightly integrated ecosystem of partners. I think that a lot of the problems we see from pure virtual care solutions is that as soon as a member leaves, they have to start over and they’re on their own. That’s where costs add up, and that’s where the member experience breaks down,” Rotenberg remarked. 

The healthcare industry certainly hasn’t perfected the type of integrated care experience that Rotenberg has described, but that is where the direction of innovation is headed — better care coordination between different providers and modalities, more convenient virtual care options and value-based payment structures.

Kevin Fyock, North American innovation and commercialization leader at Aon, said that employers are “very willing” to accept the idea of a virtual-first health plan. In his view, patients have grown a lot more comfortable leaning into virtual care since the pandemic.

“There’s a convergence of willingness to use technology alongside the evolution of virtual primary care. I feel like now is the time, more than ever, that employers are saying this is something they’re willing to try to pilot or to fully adopt. We see this as the future,” Fyock declared.

Photo: elenabs, Getty Images