Until now, access to healthcare has been geographic. In Minnesota, I often take the quality of our healthcare systems for granted, especially with the Mayo Clinic, one of the world’s best hospital systems, a short drive away. Historically, where a person lives, even down to the zip code they live in, dictates the level of access they have to quality care. For decades, our healthcare industry has structured benefits, networks, and member guidance around this geographical limitation of care.
But the past half-decade has made it abundantly clear that geography is no longer the defining constraint. Virtual care has fundamentally changed what access to care looks like, especially in specialties with provider shortages and long wait times. Additionally, and even more transformational, virtual care is expanding access to advanced care models and providers that have only been accessible to those living near major tertiary medical centers worldwide. Unfortunately, many payers’ navigation tools are built with only geographic-based care in mind. If we want to meet rising member need and deliver better outcomes at lower costs, this must change.
Consider gastrointestinal (GI) care, a specialty area representative of the mismatch between member need and the traditional access model. Nationally, average wait times to see a gastroenterologist hover around 48 days. In many markets, like Boston, Philadelphia, and Charlotte, the wait times can be significantly longer. During that time, members often bounce between urgent care and the emergency rooms — driving avoidable costs and delaying diagnosis.
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Virtual specialty networks now offer rapid access to multidisciplinary teams who can diagnose symptoms, quickly start treatment, and coordinate seamlessly with in-person providers when needed. Yet too often, members simply don’t know these options exist. This is no longer a problem of access to clinical quality — it’s a problem of navigation.
In the wake of the pandemic, many health plans and providers stood up virtual offerings in record time. The industry deserves credit for moving quickly to fill the access gaps. But speed came with trade-offs. In many cases, virtual solutions were bolted onto existing provider directories or presented as separate wellness “add-ons” rather than integrated benefits. Members were left to discern when to choose virtual versus in-person, without clear guidance. Even the best clinical solution falls short if the member experience is fragmented or confusing.
For payers, that means the work ahead is not simply contracting with virtual providers — it’s rebuilding the infrastructure that builds trust as members find the right care for them. In practice, this requires rethinking three elements:
1. Member communication and trust
Consumer trust in health plans is fragile. Industry insiders know that members are more receptive when information comes from a known entity, such as their employer, their provider or the material is co-branded with a credible clinical partner. Some plans have already begun to make this shift. For example, one Blue Cross Blue Shield plan has combined proactive communications with co-branded outreach from virtual provider partners and timely reminders triggered by member searches in their provider directory.
By treating virtual care recommendations more like consumer experiences — personalized nudges, curated options, and warm transfers to care advocates — they have driven substantially higher enrollment. In one case, enrollment in a virtual care program increased twenty-fold when co-branded outreach came directly from the clinical partner rather than the plan alone. Similarly, other health plans are leveraging targeted campaigns and culturally resonant messaging to help members recognize virtual options as credible, trusted sources of care.
2. Integration into core navigation tools
Navigation platforms are still oriented around brick-and-mortar proximity. When a member searches for specialty care, virtual options should not be relegated to a separate tab or buried at the bottom of results. They should be presented side-by-side with in-person options, even flagged for faster access and often lower cost. Some payers are experimenting with point-of-search interventions like dynamically inserting prompts or pop-ups in the provider directory when members look up certain specialties. This approach effectively “catches” members in the moment of decision-making, much like an e-commerce site informing a customer of similar products to consider.
Triage protocols are also evolving to recommend virtual care as a default entry point for conditions that require high touch care, rather than an exception. These strategies can help alleviate pressure on overburdened local systems and reduce avoidable ER visits.
3. Scale network and cost strategy for health equity
Virtual care is increasingly viewed as a core site of service — one that extends network capacity, improves affordability and supports the total health strategy of an employer or plan sponsor – and does so at-scale. Forward-thinking plans are contracting with virtual providers with higher performance guarantees, and making those options available across their entire market and accessible to every member.
Some are also adjusting benefit designs to make virtual options more appealing, reducing or eliminating out-of-pocket costs to encourage adoption. For instance, a few national health plans are enabling self-funded employers, often referred to as Administrative Services Only (ASO) clients, to implement $0 copays for virtual care by leveraging the Telehealth Safe Harbor provision. This removes a critical barrier to care and can and enhances the effectiveness of the awareness building initiatives.
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Ultimately, the most exciting part of this transformation is what it means for members. A future where geography, site of care and network design no longer defines the patient journey to timely, high-quality treatment. This can be our reality, but it requires us to finish the work that the pandemic started.
The legacy systems of geographic access won’t serve the next generation of care delivery. Payers have an opportunity, and a responsibility, to build the pathways that connect members to the right care, at the right time, wherever they are. Geography is no longer limiting care. It’s time navigation strategies caught up.
Photo: omersukrugoksu, Getty Images
Before joining virtual GI clinic Oshi Health as Vice President of Payer Strategy and Growth, Nathan Paulsen led virtual specialist network strategy for a large national health plan.
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