The new frontier in employee benefits: Virtual specialty care

The health care system doesn’t make it easy to get answers. It is often perplexing for both employees and employers to navigate the process and get access to good, timely care. Paperwork, forms, the wait to see doctors, cost, miscommunications, bad referrals, and conflicting information online all get in the way of accessing quality, timely care.

One evolving answer to this frustration is virtual care with expanded on-demand services that offer benefits brokers and consultants new opportunities to offer their clients innovative solutions to improve health care. Thanks in part to the exponential adoption during COVID, virtual care is here to stay, but it is also evolving rapidly. The traditional telemedicine platform has become a commodity, with everyone from health systems to third-party platforms to health plans offering telemedicine. In effect, it has evolved into a tool to access care through the exact same health care system. The good news is “virtual care 2.0” is bringing new personalized virtual care models to market that deliver broad, high-quality solutions beyond primary and urgent care telemedicine.

Virtual care 2.0 will be attractive to employers who are increasingly looking beyond traditional benefits offerings for new ways to support and engage their employees. Benefits professionals can play a significant role in ensuring their clients are aware of the evolving landscape and innovative solutions in virtual care that are personalized, timely, and can deploy curated networks to support condition-specific journeys.

The most significant virtual care 2.0 opportunity is in the emerging field of “virtual specialty care,” which targets the broad swath of health care where all the cost and complexity live. Virtual specialty care platforms solve the problem of speed and access to high-quality specialists, ideally in a highly personalized way. Within the medical field, specialists focus on a specific area of medicine, such as cardiology, urology, neurology, oncology, rheumatology, immunology, orthopedics, or mental health. A virtual care platform focused on specialty care can deploy sophisticated technology to customize and personalize virtual interactions with patients that are specific to a condition and patient’s journey, leading to better, more cost efficient decisions and outcomes.

Historically, virtual care models were focused on primary care or specific conditions, like diabetes. With employers struggling with overwhelming “solution fatigue”, there is a need for a new model that is broader and can deliver highly personalized impact across the spectrum of conditions – from allergies to cancer. High-quality, virtual specialty care models can deliver on the promise of reducing solution fatigue, improve decision making, and deliver a highly personalized experience that solves for the complexity and cost of specialty care.

Greater cost savings and quality of care

By offering virtual specialty care as a benefit, benefits professionals can deliver considerable cost savings to their employer clients. While most virtual care models today focus on primary or urgent care, the majority of health care costs are concentrated in specialty care. It’s an untenable situation where typically 5% of employees drive 50% or more of claims cost.

Virtual specialty care, done well, can optimize health outcomes while lowering costs by getting employees connected with high-quality specialists who support better treatment paths, education on options, and eliminating wasted appointments and tests. Some specialty care platforms have shown up to $7,150 in average savings per member engagement, resulting in a 3:1 return on investment. Engagements with the specialists on these platforms have also had profound, positive impacts on the care members received, with 33% avoiding unnecessary surgeries and treatments, 55% changing or refining a diagnosis, and 52% changing their approach to treatment.

Beyond savings, benefits professionals can also offer their clients’ employees access to higher quality care and a better patient experience. While there has been a dramatic increase in adoption rates among employers offering virtual care programs, that increase hasn’t necessarily translated into increased employee satisfaction. A survey by Summus Global found that 53% of U.S. HR professionals said their company’s employees now have access to virtual care, but only 63% of that group said their employees are currently satisfied with the offering.

Increased demand from employees for impactful solutions will drive employers to be more discriminating around virtual-care solutions, with quality as their top consideration. Instead of treating virtual care as a novelty and adding it to benefit portfolios as a box to check, employers will increasingly vet their virtual care solutions to ensure the solution meets the bar for quality and can solve the solution fatigue problem.

Virtual care 2.0 is an exciting evolution in health care, and benefits professionals have an opportunity to redefine how their clients think about care models, support better medical decision-making and health outcomes. While the challenges of the present health care system and experience can often wear down even the most resilient, frustration doesn’t have to be the norm in health care. There are real answers in virtual care.