Just about all employers and brokers agree the health plan industry needs an overhaul. That’s one of the clear takeaways from Centivo’s late 2022 Employer & Broker Health Plan Trends Survey. Exactly how to make change happen, however, is where these groups somewhat disconnect: We found that far more employers are open to innovative ideas than brokers may realize, while brokers have other issues front-of-mind.
Despite the communication gap, we believe change is possible if employers and brokers clearly communicate their openness to it. And our survey brought to light several clear starting points. One that stood out is particularly meaningful for me as a physician who believes deeply in the promise of primary care – the increasing interest in virtual primary care.
Primary Care Matters – When Patients Use It
Overwhelmingly, the survey showed that employers (95%) and brokers (94%) believe primary care plays a critical role in improved health and cost control. Yet today, primary care spending is at an alarming low in the United States – less than 5% across commercial payers – and nearly a quarter of people with commercial insurance don’t have a usual source of primary care.
Part of the problem may be the price tag. For many, having employer-sponsored health coverage doesn’t mean they can afford to use it, even for routine primary care. This is especially true with high-deductible health plans, where most primary care visits end up covered out of pocket. As a result, employees avoid getting care – a risky game that can lead to much more urgent, expensive care down the road.
For primary care to succeed as the foundation for high-performing, cost-effective healthcare, patients need the affordability and accessibility to get the right care at the right time and in the right place. Any overhaul of the health plan industry needs to support high-quality primary care now and sustain its improvements in the future.
The Virtues of Virtual
In terms of moving the healthcare needle, virtual primary care holds great promise for addressing spiraling healthcare costs, increasing the accessibility of quality primary care, and resolving other barriers around DEI and beyond. Perhaps the fastest-growing healthcare innovation these days, virtual primary care – sometimes called virtual-first or digital-first care – shifts the concept of off-hours or urgent telemedicine visits as a supplement to having a virtual doctor as a replacement of the traditional in-office primary care relationship.
Virtual primary care meets patients where (and when) they are, eliminating geographic, physical, and scheduling barriers to care. And that’s a practical and effective way to bring care-avoidant or “medically homeless” (those without a primary care provider) back into the healthcare system, so the emergency room doesn’t become the first point of care.
When virtual primary care is built into a health plan offering, it can be an attractive option for plan members who want the flexibility of virtual visits, but the care continuum of a strong PCP relationship. Embedding a virtual primary care practice into a health plan means patients can develop a rich rapport with their virtual team and makes it easy to coordinate any needed in-person or specialty care with in-network doctors.
Virtual Care and the Comfort Zone
The idea of moving from a “high-touch” office-visit realm to a digital interface has employers and brokers intrigued but cautious. About 84% of employers surveyed would consider including virtual primary care as an option for employee coverage and believe it has potential for reducing the number of medically homeless. But our results showed only slightly more than half of employers would consider moving to a health plan that only utilizes virtual primary care.
The good news for those who don’t want to go all-VPC-or-nothing: Employers can explore a range of options and features when considering adding a virtual primary care component to their health plan. They have a sweeping gamut of virtual primary care practices to consider, from on-demand, one-off virtual primary care visits all the way to truly integrated practices that sit within employer-sponsored health plans (as described above).
Even in a fully virtual primary care practice, certain situations will, of course, require hands-on, in-person care. Employers – and their employees getting care – can rest assured that, if needed, virtual primary care doctors can work with in-network specialists (who might be virtual or in-person) to guide patients with complex needs to get the right diagnosis and treatment.
Continue the Conversation
Change – especially when it involves a greater focus on primary care – can be an extremely positive thing. That’s why I believe the ongoing evolution and acceptance of virtual primary care as a health plan component can be an important remedy for what’s ailing the healthcare system. I encourage all employers and their brokers to have open dialogues about healthcare innovation and keep the momentum moving forward.
Wayne Jenkins, M.D., is Chief Medical Officer at Centivo.