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Though training is necessary, payers see value in telehealth-first health plans

As demand for telehealth reached new heights in 2020, payers raced to develop telehealth-first insurance products — where the interaction between the plan member and their provider is primarily virtual — to launch this year. And these products are here to stay.

While there are some challenges associated with bringing these plans to market — namely upfront patient and physician education — the pros far outweigh the initial cons, according to Ceci Connolly, president and CEO of Washington, D.C.-based Alliance of Community Health Plans, and Carrie Kincaid, vice president of individual markets at Michigan-based health insurer Priority Health. Connolly recently co-authored a piece in NEJM Catalyst about the rise of telehealth-first plans through the lens of three insurers, including Priority Health.

Telehealth-first insurance plans are identical to brick-and-mortar health plans, with the only difference being that the format is virtual, Kincaid said in a phone interview. But this makes all the difference when it comes to making care more convenient and lowering costs.

For example, Grand Rapids, Michigan-based Priority Health’s MyPriority Telehealth PCP plan allows members to select a primary care provider that they would see virtually. If the patient has an acute care need and their PCP is not available, they would be able to see another physician. The premium for this product is 6%-8% lower, on average, than the payer’s other plan offerings on the individual market, according to the NEJM Catalyst article.

The payer partnered with virtual care company Doctor On Demand for the telehealth services, through which patients have access to the company’s entire care team, including doctors, nurses, care managers, psychologists, psychiatrists and nutritionists. If the patient needs an in-person visit, the Doctor On Demand physician works with them to select a location within the plans’ broader network.

Though telehealth-first insurance products have some differences in terms of how they operate or the benefits they offer, they have the same goal — “…to meet the patient where they are and make access to care convenient and very importantly affordable,” Connolly said in a phone interview.

“Certainly, our nonprofit community health plans approach this with an emphasis on the patient-physician relationship, and that can just as easily be forged via technologies as in-person,” she said.

Though the Covid-19 pandemic certainly spurred the development of these plans, it is a common misconception that the products were born out of the public health crisis. At Priority Health, conversations about virtual-first plans began pre-pandemic, as research was already showing that access to primary care was a challenge for patients, Kincaid said.

But bringing these plans to market came with its own unique challenges. One of the major ones was displaying the virtual-first products on ACA marketplace website, where the format is pre-defined, Kincaid said. As a result, Priority Health found it hard to convey to consumers what made this plan different.

“We knew we would have some challenges where people would sign up for this product and maybe not fully understand what they purchased,” she said. “We didn’t want anyone to buy this product and have it feel like [it is] a mismatch.”

So, the payer focused on patient education, making welcome phone calls to enrollees to make sure they understood what they bought and ascertain that it would be a good plan for them, Kincaid said.

Others did not take the route of education, investing instead in providing common medical devices through a welcome package.

Harvard Pilgrim Health Care which launched its SimplyVirtual plan in time for the 2021 enrollment period, invested in personalized welcome toolkits for its members — that included thermometers, blood pressure cuffs and other remote monitoring devices — said Connolly of Alliance of Community Health Plans.

Engaging consumers was one piece of the puzzle.

A key hurdle these plans faced was getting the buy-in and support of physicians and clinical teams. To garner support, payers launching telehealth-first plans set up training sessions for clinical care teams that not only focused on the technology aspect of care delivery, but also on webside manners, Connolly said.

But one area where these plans don’t face too much resistance is state approval. Though state laws can slow down the process of bringing virtual-first plans to market, they are usually approved as regulators are in favor of insurance products that can reduce the high price of healthcare and expand access to care, Kincaid said.

Not only that, the plans appear to be popular with the most important stakeholder in the healthcare business — the patient.

Priority Health expected to enroll 3,000 members in 2021, and ended up enrolling 5,000, more than 2,000 of whom transitioned from other Priority Health products, the NEJM Catalyst article shows.

“Virtual care is here to stay,” Connolly said. “Consumers are demanding it. Health systems and health plans make a terrible mistake if they think we are returning to pre-pandemic way of life.”

Photo: elenabs, Getty Images