A few years ago, the pandemic catalyzed a new era of “virtual-first” healthcare — often understood as a care delivery model in which providers use online platforms, telemedicine centers and other digital tools to deliver medical services such as consultations, diagnostics and refills with a prescription.
A week ago, HLTH host of a webinar in which leaders assessed the growth of Virtual First Health Plans. The panelists agreed that if executed well, virtual health plans have significant potential to reduce costs and improve the member experience.
Firefly Health CEO Faye Rothenberg said she’s not a big fan of the term “virtual first.” Fireflywho is sponsoring the webinar is a virtual primary care start-up that launched own health plan for employers in 2021.
“I think that [the term] is very diluted by linking to much narrower solutions. I want it to mean that the virtual becomes an integral part of all care – seamlessly integrated. Right now, I think people just don’t know what that means, and the industry as a whole has yet to agree on what the tenants of a first virtual plan should be, other than providing broad, discounted access to virtual care as part of the plan design.” Rothenberg said.
Virtual First Health Plans must go beyond simply providing access to virtual care services — which, if done poorly, can actually increase the overall cost of care and lead to a fragmented, frustrating member experience, she argued.
A virtual primary health plan should look like “an archipelago of unconnected islands,” Rotenberg explained. According to her, it should be a bridging system, bringing together all aspects of care and coverage.
Ashley Yates, vice president of medical operations at Blue Cross Blue Shield of Massachusetts, agreed with Rothenberg. He said he is excited about the potential of virtual primary care plans to connect all the different stakeholders involved in a patient’s health journey – such as payers, pharmacists, nutritionists, mental health providers, specialists, surgeons and primary care providers.
By having this big picture of a member’s healthcare journey, virtual health plans can detect gaps in care and track members to ensure they are getting the services they need, Yates noted.
“This follow-up ensures that the member understands what just happened during their visit and can connect the dots to refill prescriptions and get the personal care they may need,” he said.
Rothenberg added that risk-advanced primary care should be the basis of a virtual primary health plan, ideally free to members. This ensures greater accountability and consistency across quality and cost outcomes, she said. She also said patients need primary care delivered through an easy-to-use digital platform that can easily direct them to all the in-person services they need.
“There needs to be an approach to personal care services that includes a tightly integrated ecosystem of partners. I think a lot of the problems we see from pure virtual care solutions is that as soon as a member leaves, they have to start over and they’re left alone. That’s where the costs pile up and that’s where the member experience falls apart,” Rothenberg noted.
The healthcare industry certainly hasn’t perfected the kind of integrated care described by Rothenberg, but that’s where the direction of innovation is headed—better coordination of care across different providers and modalities, more convenient virtual care options, and value-based payment structures .
Kevin Fock, North American Innovation and Commercialization Leader Aon, said employers are “very willing” to embrace the idea of a virtual first health plan. According to him, since the pandemic, patients have become much more comfortable to rely on virtual care.
“There is a convergence of desire to use technology along with the evolution of virtual primary care. I feel like now is the time, more than ever, for employers to say this is something they’re willing to try to pilot or fully embrace. We see this as the future,” said Fock.
Photo: elenabs, Getty Images
