Is insurance focused on virtual visits? The pros and cons of a new twist on health plans

The concept of Virtual-First was so new that Priority Health called members this year to make sure they understood how it worked. “If people were more comfortable in the normal environment, they should have chosen other options,” Kinkade said, adding that the plans have attracted 5,000 applicants since January, and she hopes the number will double next year.

There are other versions of telemedicine plans available from well-known companies such as Humana, Kaiser Permanente, Oscar, and UnitedHealthcare. Some emphasize but do not require primary health care to start online. Some are aimed directly at consumers. The rest are sold to employers.

Sold in multiple states, including Texas, Florida, and New York, Oscar Virtual Care plans allow patients to choose between online or face-to-face services.

“These are not just virtual plans,” said Marianne Spanos, Oscar’s vice president and general manager of the virtual care business. “You can always choose a more traditional supplier.”

Although Kaiser Permanente employs its own medical staff, most insurance companies rely on contract doctors, psychotherapists and other staff, often provided by Doctor on Demand, a San Francisco-based company.

Doctor on Demand was launched in 2013 and is aimed at individual consumers. Starting with a contract with Humana in 2019, it has since expanded to offer staff for several other insurance companies. The company, which has its own electronic health records system, is hiring a number of primary health care, mental health and other health care providers. Doctors must be certified. The payment depends in part on how many patients they accept, and there is no upper limit. Some want to work part-time, for example, and many work from home.

Typically, Virtual-First health plans can offer lower premiums or provide financial incentives such as no co-pay for online visits. All boast that attendees can make appointments quickly, sometimes in minutes. Patients with serious problems are assisted in organizing emergency care. If online doctors determine that patients need a blood test, immunization, or specialist visit, they refer them to a local clinic, clinic, or specialist in the insurer’s network.

Consider HMO 2.0 as a cost containment strategy.

“There is more control over patient interactions and referrals,” said Sabrina Corlett, research professor and co-director of the Center for Health Insurance Reforms at Georgetown University.

However, patients should be aware that some of these plans may only allow routine visits if their virtual doctor, who may never have seen them in person, deems it necessary.

Skeptics point out that many circumstances require personal care… One recent study found that this was required for about 66% of primary health care visits. For example, it is impossible to check reflexes and virtually examine the tonsils for infection.

Some programs, including Harvard Pilgrim’s, are sent kits, which may include devices such as blood pressure cuffs and thermometers, although home medical meters are often not as accurate as those used in offices. Online doctors may also ask the patient to feel the enlarged lymph nodes, shine a light down the throat while filming, or take other actions. to help the doctor diagnose the problem

Priority Health’s Kinkade noted that Doctor on Demand also sets up protocols for wellness visits to children, which he says should be done in person.

“Accurate measurements of height and weight and immunizations are important for wellness visits to children,” Kinkade said.

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