How UnitedHealth, Aetna and Centene are addressing the challenge of virtual first aid

Insurance companies are betting heavily on people continuing to use virtual assistance after the pandemic, with UnitedHealth Group, Centene Corp. and CVS Health’s Aetna recently announced new Virtual-First offerings.

According to a report released last month by consulting firm Mercer, an employee benefit consulting firm, 72% of employees said they plan to “continue using” telehealth after the public health crisis is over. Among individual clients, telemedicine use fell to 4.2% of all visits in July, although virtual visits remained popular in some specialties such as psychotherapy, with 60.8% of sessions being conducted remotely, according to FAIR Health Monthly Regional Telemedicine Tracker… In response to demand from employers and consumers, insurers continue to launch virtual first plans, although their go-to-market strategy depends on the insurer. These recent announcements by national commercial insurance companies follow the launch of Virtual-First plans by regional payers in early 2020.

“There is a lot of effort now,” said Dina Bell, director and consulting actuary at Milliman. “Finding out where telemedicine will stabilize and having health plans with extensive experience in contracting with providers, and vice versa.”

Health plans believe that by expanding access and shifting the cost of care to cheaper facilities, they can reduce costs. And in all of these plans, consumers do not need to pay a co-pay to visit virtual doctors, which also allows members to save on healthcare costs. But because these plans are so new, the data on how much they save on health care costs for insurers is mixed, with some saying virtual-first plans may act as an unnecessary gatekeeper for treatment and ultimately just delay possible patient visits. hospitals. provider person. Questions also remain about what the long-term reimbursement for these services should look like, Bell said.

“You can’t do everything with telemedicine,” Bell said. “This is a great place to start when answering questions about whether to do something more intense. Don’t google your own stuff, start with a telemedicine provider. I think this is a promise. But it will be interesting now to see if employers and consumers will go for it, or if they are tired of it, faced with it throughout the pandemic. ”

Insurance subsidiary UnitedHealth Group unveiled its first virtual-first plan on Tuesday, which will be available to employers in nine markets in 2022 and combines the Optum physicians division with its UnitedHealthcare insurance network. Under the NavigateNOW name, Optum’s 60,000 physicians will oversee virtual primary, emergency and behavioral health services for individuals, and the UnitedHealthcare physician network is available as a back-up for any personal need, spanning over 1,600 facilities across Optum’s national outpatient provider network.

Enrolled members will receive a personalized care team and have access to a wearable device for a wellness program that offers financial benefits to meet specific health goals.

UnitedHealth Group said it plans to cut insurance premiums by 15% over more traditional offerings by identifying patients’ health problems earlier and referring them to treatment at the lowest cost. By the end of 2022, the company plans to introduce it in 25 markets and is “watching this in a self-financed manner,” said Dr. Donna O’Shea, Chief Medical Officer of the Health Service. She declined to comment on the number of members that UnitedHealthcare plans to enroll in its virtual plan.

“If it works, then this model can be promoted nationwide, right?” O’Shea said. “We think of it more as an integrated health care system, as we do across the country. But it just so happens that we are a national, not a regional system, and therefore we have different capabilities and different responsibilities to meet the needs of our members. “

By creating an internal system, UnitedHealth Group can store patient health information in one place, O’Shea said, making it easier for providers to access across the country and ensuring that members are referred to the right specialist. Cigna is also pursuing a similar internal strategy through its acquisition of MDLive earlier this year, with some saying the company plans to sell its virtual capabilities to other smaller healthcare plans.

Meanwhile, other insurers are looking for virtual providers outside of their company.

Centene Amwell announced Tuesday that it is partnering with Teladoc Health to launch a virtual plan for exchange clients across four states in 2022. Last week, CVS Aetna also announced a partnership with Teladoc to launch its virtual primary health care services across the country. Both will rely on Primary360’s tool to expand their digital offerings, said Robert Bressler, senior vice president of Primary360 at Teladoc.

Bressler declined to comment on the number of providers Teladoc hired and the number of payer lives that Teladoc is responsible for. But he said plan sponsors typically see 10% savings when they partner with a company to create a virtual plan.

At the end of the last second quarter, Teladoc reported 3.5 million visits, up 28% from 2.7 million in the same period last year. During the quarter, the company also logged over 1 million “platform sessions” where healthcare systems use its product to communicate with patients. This feature was not available a year earlier.

“Virtual primary health care as a category is truly the future and a mega-trend,” Bressler said. “This is a shift in the virtual health care industry as we move away from simple transactions and a more urgent care model to truly long-term relationships with service providers.”

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