Virtual care and health navigation company Included Health plans to launch a virtual-first specialty care clinic to give its members easier access to more than 4,000 specialist physicians, support services and care navigation.
The company will launch three virtual-first specialty care clinics in 2025 focused on cancer care, women's health and metabolic health. For the latter two centers, Included Health will initially focus on offering member programs for menopause and healthy weight, according to Ami Parekh, M.D., Included Health's chief health officer.
The company plans to roll out other specialty care programs. "This is just the start of where we think we can go with specialty care," Parekh said.
The new virtual-first clinics will connect expert medical opinion, primary care, mental health and navigation capabilities to tackle specialty care access and high costs and offer services personalized to members' health benefits and preferences, according to the company.
Through this new model, Included Health members will have access to specialist appointments in under seven days and in-home medical prescription, diagnostic and monitoring support.
"We are motivated mostly by what we see our members needing. So, where do we see gaps in their care journey that we think we can help make better in a significant way? What we found was that while we have made incredible strides in access to primary care, behavioral health, and expert medical opinions, our members were still falling through some cracks when it came to accessing care to address specialty needs," Parekh said in an interview.
Included Health works with employers and health plans and provides healthcare benefits and insurance navigation along with virtual primary care, behavioral health, specialty care, expert medical opinions and all-hour urgent care appointments.
Included Health's expansion into specialty care comes as U.S. patients wait longer to get appointments with medical specialists.
The average wait time for new-patient, non-emergent appointments across five specialties is 26 days, up 8% from 2017, according to a 2022 survey from AMN Healthcare and Merritt Hawkins. The survey focused on five medical specialties: cardiology, dermatology, obstetrics-gynecology, orthopedic surgery and family medicine.
In some cities, the average wait time stretches to 45 to 59 days to see certain specialists.
"If you're a woman going through menopause symptoms, even just figuring out what kind of clinician you should talk to can be very hard. So, you just might not get that care met at all," Parekh said. "That's where we always start from: Is there a member need that we think we can improve access to and meet in an integrated, differentiated way?"
Specialty care also can be expensive and require more out-of-pocket costs for patients.
The average cost of medical care and drugs is more than $42,000 in the year following a cancer diagnosis, according to one 2020 estimate. More than 40% of patients spend their entire life savings within the first two years of cancer treatment, one study found. Many cancer patients face significant financial hardships and report problems paying for medical bills, borrowing money, or even filing for bankruptcy.
"Cancer care was obvious to us because it's so fragmented and our patients are definitely not getting the optimal care. There is an opportunity to leverage our capabilities, navigation and advocacy services as well as our clinical expertise," Parekh said. "Healthcare is still the number one cause of bankruptcy in the United States, and cancer patients face very large medical bills. They're very worried about the financial and administrative hassle of managing this new diagnosis. So, bringing all of our advocacy skills to bear on this population will be very helpful."
Patients often struggle to coordinate care between a primary care doctor, oncologists, surgeons and radiation oncologists, she noted. "We know some people just have a hard time finding the best cancer care expert for them. We know that cancer patients wake up at 3 am with symptoms and they can't get hold of anyone because they're nauseous or are having pain. How do we help with the wraparound symptom management type services?"
Employers also are feeling the pinch of rising healthcare costs. Half of employers said cancer is the number one driver of healthcare costs while 86% said it was in their top three, according to a 2023 survey from the Business Group on Health. Other top drivers include musculoskeletal conditions, cardiovascular conditions and diabetes.
"A number of our clients have come to us saying, 'We have employees and dependents who are struggling in getting access to high-quality specialty care, can you help us?' There was a member need and there was a client need," Parekh said. "We can put together our technology capabilities and our clinical capabilities to meaningfully make a difference."
For menopause and healthy weight, Included Health executives recognized an access problem, "where virtual care can fill a large part of the gap," Parekh said.
As part of the healthy weight program, Included Health specialist physicians can prescribe weight loss medications, including GLP-1 drugs, depending on the coverage of the member's health insurance plan, Parekh noted.
Included Health was built out of the merger of Grand Rounds Health and Doctor on Demand in 2021. The combination brought together Grand Rounds' capabilities to virtually connect patients with top-ranked medical experts for a second opinion with Doctor On Demand's service to provide on-demand and scheduled visits with healthcare providers in both medical and behavioral health.
Specialty care is a natural extension of what the company has been building over the past three years.
"I don't think we could have done this in reverse order. I think it's critical that we had the foundation of navigation and the foundation of primary care and behavioral health that sets us up to be able to do specialty care in a truly differentiated way," Parekh said.
The company's focus is to offer an integrated healthcare experience where members can access primary, behavioral health and specialty care in a virtual-first way all in one place along with addressing administrative and financial issues, she noted.
Included Health's on-staff multidisciplinary clinical team includes primary care clinicians and providers to address urgent care and behavioral health needs.
The company also has built a nationwide network of 4,000-plus specialists and subspecialists supported by partnerships with more than 40 hospitals and health systems. Those health system partnerships are one key differentiator from other telehealth companies, Parekh said.
"We will absolutely be leveraging those relationships as we bring high-quality care to our members through the cancer care center," she noted. "Some of that can be done by our in-house clinicians, but there will be a percentage of patients who really need expert care. I do imagine over the next few years, as we continue to innovate here, we will be exploring even new partnership models with providers."
With the specialty care clinic, members will benefit from a dedicated care team led by specialists experienced in everything from symptom management to acute needs, with integrated primary care and mental health support. The service also includes in-home support for medical prescription, diagnostic and monitoring, and members will receive assistance with administrative tasks such as scheduling appointments and organizing records and scans, according to the company.
The specialty care clinic model is an evolution of Included Health’s expert medical opinion service, which, according to the company's data, can save an average of $9,800 per member case and lead to improved outcomes in 66% of cases. That average cost savings jumps to nearly $16,000 per member case after an expert medical opinion leads to a change in treatment, according to the company.
Patients often face long, complicated specialty care journeys, noted Owen Tripp, chief executive officer and founder, Included Health "We’ve long known that to truly impact both the cost and quality of care, we must guide people towards the best care paths and support them in an integrated, personalized way. We’re excited to do this for people and for employers, both of whom are overwhelmed with an excess of point solutions and with the repercussions of the fragmentation across the specialty care continuum," Tripp said.