These past experiences have driven two converging realizations: buying and managing vendor point solutions for every condition area isn't sustainable and the most effective solutions are those delivering proven medical care and interventions delivered by clinicians that are built into the health plan.

One intriguing solution that has begun to gain momentum is the use of customer-specific networks (often abbreviated as CSNs or CSPs by carriers). This structure allows employers to more quickly and easily gain access to innovative new providers as "in-network" from their carrier while getting the benefits of improved access, accountability and cost reduction with lower administrative burden.

Employers driving coverage innovation

Health plans have always played a key role in delivering and curating employer-covered health care offerings. But with the complexity of building and maintaining large provider networks and quickly advancing technology trends paired with their rigorous vetting process, the plans have long been limited in their ability to keep up with the needs of their employer clients, despite their best intentions. Within this dynamic, more employers have transitioned to self-insured models, assuming both financial risk as well as the responsibility to foster a healthier workforce.

This accountability for cost is driving creativity and change in the levers that employers are using. A decade ago, employers focused on overall health and wellness, with less concern for conditions that require specialty care providers like diabetes, musculoskeletal, mental health, or digestive diseases. However, due to their increasing prevalence and rising attributable costs, there has been a dramatic shift towards employers directly identifying and implementing specialty care partners to address these top high-cost conditions, as well as taking an active role in shaping plan design to drive behaviors known to improve population health outcomes and costs.

This has placed significant pressure on employers, and positioned them at the tip of the innovation spear when many benefit leaders would still ideally prefer that the health plan would serve as the foundation of their health care offering, and be customizable to meet their unique needs.

The path to virtual specialty care

Throughout this transition, employers have tried many new approaches – like onsite clinics, contracts with Centers of Excellence in distant cities, and partnerships with point solution vendors – to plug the holes in their coverage and address high-priority medical conditions. While these innovative pushes by employers have helped move the industry forward, they have also created additional work and now "point solution fatigue" for benefits teams.

Some of these point solution vendors have attempted to broaden their condition coverage to become one-stop-shops for benefit buyers and their members, but many lack the clinical depth required to resolve complex conditions that require specialized licensed clinicians, rather than technology or coaching-focused models. Moreover, there is significant variance in quality among point solution vendors, with many not delivering promised outcomes or cost savings.

A new breed of virtual specialty care providers are emerging that fulfill the promise of better outcomes and accountability for cost reduction while avoiding the pitfalls of one-off point solution vendors. These new companies provide completely redesigned care, – going beyond simply digitizing an appointment to provide an end-to-end personalized care experience that diagnoses, treats, and, coordinates care in the local community and serves as a support system even after the employee has achieved their health goals.

These providers deliver real medical care via licensed clinicians with specialized training in proven interventions, many of which are not often available at scale in the local community. In specific instances like digestive health, musculoskeletal, and women's health, clinical trials have proven virtual specialty care's ability to deliver lasting symptom relief faster and with a greater positive impact to overall health care spend over time than traditional care alone.

While some health plans have begun to include virtual specialty care providers as in-network providers, most are still playing catch up – waiting for the data behind virtual specialty care and the employer signal to scale access to this proven option. This has left employers again in the position of having to innovate in order to offer a compelling new provider option to their workers until insurers are able to meet these same needs.

Custom networks as a fast-track to virtual specialty care

Early adopters have begun to request that their carriers establish custom networks as a creative workaround or stopgap solution to provide proven virtual specialty care coverage for their members until health plans that include virtual specialty providers become the norm, and not the exception.

Related: Hospitals charged private insurers 254% more than Medicare paid: RAND report

A custom network neatly splits the difference of direct contracts between employers and an individual provider and a standard provider network contract to provide the best of both worlds. It has all the advantages of a direct contract – waived member cost share (this can be a key lever for engagement and utilization of new provider offerings), customizable referrals with other benefit offerings & providers, population-specific reporting – coupled with the ease of the billing going through medical claims so that it can be aggregated with other medical spend and administered by the health plan. There is also typically little or no additional contracting, so employers can have these speciality providers up and running within months.

Finally, if enough employers engage with virtual specialty care via custom networks it provides an opportunity for health plans to study and monitor real-world data and outcomes within their populations. This, in turn, equips them with the necessary insights to implement this care on a larger scale – adding these providers to their broader regional or national network for both their fully-insured population as well as self-funded employers.

Securing a custom network for your workforce

Insurers don't always tout these networks to employers due to the added administrative burden to set them up and maintain them on their end. However, if your carrier has already set up a custom network for an employer customer, they typically can add additional employer customers with relatively little additional effort. It's just a matter of asking. And if your carrier has not yet set up an innovative provider in a custom network, there's still no work for the employer – the health plan and virtual care provider can swiftly create one behind the scenes regardless of geographic location.

All an employer has to do is reach out to their health plan account executive to express their interest and get the process started. It couldn't be easier. And the more employers add to the chorus making these requests, the more motivated health plans will be to fully add these innovative providers to their networks and scale access to care that is so critically needed.

Randy Forman is the chief commercial officer for Oshi Health, the virtual center of excellence for GI care that's being added to health plan networks nationwide.