Visana Health, a virtual women’s health provider, has redesigned its annual visit to be more comprehensive and personalized.
Visana’s Complete Women’s Health Visit combines preventive care, symptom evaluation and expertise across gynecology, primary care and endocrinology to tailor care to each patient. The telehealth visits are 45 minutes long and go beyond a pap smear and mammogram to include hormonal, metabolic, cardiovascular, reproductive, sexual and emotional wellbeing assessments.
“It’s really a tailored visit to the individual and then optimized for what her risks are and what her questions are,” Barbara Levy, M.D., chief medical officer at Visana, told Fierce Healthcare.
Under the Affordable Care Act, most women are entitled to one fully covered annual wellness visit with no copay or deductible. Yet today these visits often leave women without complete answers to their symptoms or surprise bills, Levy explained. Many decades ago, primary care physicians performed pap smears and pelvic exams. Over time, these got relegated to the OBGYN specialty, creating silos that lead to less holistic visits. Today, preventive visits are rushed and far from comprehensive.
“Providers have gotten to the point where they’re so stretched for time that they can’t really address all of the life-course issues that are happening to people at certain times of their lives,” Levy said.
While there’s a time and place to bill for extra labs or procedures, it’s not uncommon for women to get told to come back for another appointment even when dealing with symptoms related to women's health like menopause, such as hot flashes. This means the follow-up visit will have a copay. Age-appropriate counseling should have always been included in preventive visits, argues Levy. Yet providers today are ill-equipped to treat menopause.
“It’s a misinterpretation in some ways of what a preventive visit ought to be. No one ever said you don’t talk about problems at the preventive visit. However, when there's a significant additional problem that’s brought up as a visit and it gets addressed, that can be separately coded,” Levy noted.
As part of the annual visit, Visana clinicians may recommend advanced labs like comprehensive thyroid testing, a cardiometabolic panel, a lipids panel, vitamin D, baseline insulin and more. While these may not be completely covered by a patient’s insurance, Visana aims to make that clear so they don’t face surprise medical bills.
In a survey of U.S. consumers earlier this year, Visana found that 62% of non-Visana patients turn to Google for health questions their provider did not answer and a fifth report using ChatGPT. It also found that a third of non-Visana patients received an unexpected medical bill after bringing up a health concern after an annual visit. This also has a discouraging effect: one in six patients avoided discussing certain symptoms because they feared additional bills.
In the initial rollout of the new annual visit, Visana has found 87% of patients said all or most of their concerns were addressed. Visana coordinates with external providers as needed to avoid repeating labs and for referrals to in-person care.
Levy believes not only is there a provider education issue, but also a payment issue. The fee-for-service system does not incent providers to offer longer visits or look at a patient holistically. A classic problem is a patient ends up with many different specialists, none of whom talk to each other.
“Then you get 14 meds all of a sudden, and then you get all the side effects of the 14 meds, and you don’t actually get to the root cause,” Levy said. “Can we decide as a society that we want to do wellness care, not illness care, in an evidence-based way?”
Many of Visana’s payer contracts have a value-based component, like a care coordination fee or a shared savings arrangement. Visana claims to reduce employer medical costs by 34%, cut unnecessary procedures by 78% and deliver more than $2,400 in annual savings per enrollee.