Virtual primary care: Relational care without geographic boundaries

The telemedicine delivery model has dominated the health care space over the past several years, and employer support has contributed significantly to its increased popularity. Many employers offer bundled or standalone telemedicine services as a supplement to employee health plans, and those with employer-sponsored clinics often provide the service as a coverage option for remote employee populations. For many patients who had never had a telemedicine visit previously, 2020 became the catalyst: As the pandemic forced more primary care practices to offer telehealth, the solution’s obvious benefits — safety, convenience and accessibility — took center stage.

More recently, forward-thinking health care professionals have begun to highlight the longer-term consequences of a large-scale shift to tele-based care — and for good reason. The financial implications alone give one pause: A 2017 study in HealthAffairs found that telemedicine increased rather than reduced health spending; its cost-per-encounter billing model can often come with a hefty price tag for employees; and its lack of plan integration prevents referrals to high-quality and cost-effective local providers.

The biggest danger of telemedicine, however, is the “box of chocolates” problem. When a patient signs on for a telemedicine appointment, they never know what they’re going to get. With a new provider every visit, no access to historical medical records, and limited follow-up capabilities, telemedicine offers zero continuity and risks significant gaps in patient care. Add to this the medical homelessness that results from a false sense of security in telehealth services, and the current trajectory of virtual health care has the potential to completely eliminate the doctor-patient relationship. The data proves this out: A recent Deloitte study found that despite increased usage of telemedicine in 2020, fewer patients overall were happy with their virtual clinician.

Related: 5 top health care trends to look for in 2021

Yet telehealth is here to stay, and the benefits that built its following persist. Enhanced care accessibility is crucial, especially for underserved populations, and the digital revolution demands a future of virtual health care access. Virtual care cannot and should not be eliminated; but it must be course corrected.

A better, scalable solution for the self-funded

The path forward may be found in virtual primary care, a delivery model that allows virtual access to a consistent, broad-scope primary care provider. In such a model, patients receive a much broader scope of services, including preventive care, from a provider that knows their medical history, their place of employment and health care benefits, their social and behavioral risk factors.

Care continuity and patient risk reduction are central tenets of VPC, which places an emphasis on chronic condition management and closing gaps in care. VPC vendors maintain direct contracts with national and regional labs to provide convenient and cost-effective testing, allowing providers to monitor key biometric indicators throughout the care relationship.

The financial benefits are equally appealing. VPC is either billed on an employer-paid PMPM basis, offering unlimited access for patients, or on an employer or employee-paid per-encounter basis comparable to the copay of a traditional doctor’s office visit. The model is flexible, working either through insurance or direct care. And because providers can offer deeper integration with the plan design, VPC helps maximize plan benefits through smart referrals.

The value of VPC over traditional telemedicine services has already been noticed within the benefits industry. Boutique third-party administrators, carriers, reference-based pricing organizations, and health systems entering into value-based care agreements are paying close attention to and incorporating VPC providers into their plans and services. They see the opportunities for layering a nationwide primary care access point alongside traditional fee-for-service contracts as a cost-effective means of improving member outcomes and controlling or mitigating risk within their populations.

Considerations for incorporating virtual primary care

VPC is a strong solution for employers looking to scale patient centered medical homes for their employees, especially those with widely dispersed populations who cannot build brick and mortar facilities in each of their locations. While many employer-sponsored clinic providers may be able to practice in different states (especially during relaxation of licensing during COVID), it is not always feasible — whether due to licensing or volume — for large, highly dispersed employers to provide broad-scope virtual primary care using only their onsite clinic physicians. A distinct VPC solution can eliminate this concern, allowing remote employees to have the same level of attention and depth of provider relationships as their headquartered counterparts.

Yet as with any technology-based service, employers and consultants interested in VPC should consider how easily the service could be adopted within their employee populations. While some VPC providers can be accessed simply by dialing a phone number, others may require downloading smartphone apps or logging in through a web portal. Before purchasing a VPC service, employers should consider the technological literacy of their employees and their ability to easily access internet services, which could be challenging in some rural or impoverished communities. Even when employees are comfortable using technology, benefits professionals should consider whether generational or cultural factors may affect employees’ comfort in adopting VPC — positively or negatively.

As with any employee benefit, the value of VPC is realized only when its services are used, so when implementing a VPC service, employers and consultants must effectively promote the service to employees to drive higher usage and engagement. Employers and their VPC providers can partner to identify and implement effective strategies to market the service to employees, especially during open enrollment, and may look for changes to their plans designed to encourage use of VPC as a highly accessible, cost effective option for employees’ everyday health care needs.

Measuring the value

Many primary care and wellness vendors report their value to the employer by assigning an often arbitrary “fair market value” to the services provided over a time period. High performance partners should instead be able to demonstrate their value through transparency and select metrics which answer the two questions most relevant to benefits professionals: Is the service keeping or making employees healthy and is it saving the plan money?

Population health measures showing how the vendor is moving the needle on health outcomes are critical to answering the first question. As for the second, self-funded employers and their consultants should monitor the overall cost of care for their population. Over time, the employer should be able to see the impacts in lower medical and pharmacy spend among populations using the service, especially compared to historical or industry trends. High performance vendors should report the information necessary to answer these questions to the benefits team and can be a valuable partner when interpreting and strategizing health and financial trends, both good and bad.

Just as employers and consultants helped usher in the age of telehealth, their early adoption of virtual primary care will be essential to ensuring that the patient-provider relationship is brought into the virtual health care space in the coming months and years. While in-person care will always yield maximum benefits for patients and employers, virtual primary care is the evolution of productive, patient-centered telemedicine.

Jeremy VanderKnyff is Executive Vice President, Health Data Science, Value and Validation at Proactive MD.