Fierce JPM Week: How virtual-first plans are tackling the balance between in-person, digital care

Amid the industry's telehealth boom, health insurers are putting a focus on the potential of virtual care through virtual-first plan designs.

These plans center digital health solutions such as virtual primary care in tandem with in-person care when it makes the most sense for members. The goal, executives said during a panel session at Fierce JPM Week on Thursday morning, is to enhance accessibility and affordability.

Carrie Kincaid, vice president of individual markets at Priority Health, said that virtual options enable people to squeeze routine care into a busy schedule, and the consumer reaction to having that choice is a positive one.

"They don't have the flexibility to say, 'I need an hour and a half to go to my doctor's office,'" she said. "So that was the accessibility we were looking to provide."


The challenge, then, is to offer these plans in a way that strikes the balance between virtual and in-person services for the member, which can be different based on an individual's needs. Jill Dailey, vice president of commercial product and strategic programs at Aetna, said the insurer views a seamless member experience as the key to success in this.

For example, if a consumer orders something from Amazon and decides to return it, they can do so at their local Whole Foods, which eases the process and makes it more convenient. She said these examples in other industries can be brought to healthcare to improve experience.

For a virtual-first plan, she said, it's critical to get the care coordination right so that care planning and data sharing occur before the patient connects to a virtual visit or visits their doctor in person. This also makes it easier to initiate referrals during or after a visit.

"We really think that it's all about having this seamless hybrid experience that's going to help members reach their best help, as opposed to trying to necessarily strike a balance, as it's going to be different for every individual based on what their health needs are," she said.

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Some insurers, such as Cigna and UnitedHealthcare, are launching virtual-first plans that build on the tools they already have access internally, namely virtual care platforms integrated with the enterprise. Others, however, are teaming with established telehealth providers like Teladoc to launch these options.

Kelly Bliss, president of U.S. Group Health at Teladoc Health, said during the panel that as telehealth use skyrocketed under the pandemic, the company found that consumers perceive the care to be of equal or higher quality than in-person services.

"Some of those barriers to how consumers might think about how care has shifted," she said.

Critics of the rise in virtual care have expressed concern that it could drive up costs by encouraging unnecessary services, or lead to duplicative services. The panelists said that largely this is a trend that hasn't held in their experience.

"We've actually seen the opposite of that, which to be honest early on probably surprised us a little bit," said Shawna Dodds, vice president of product development at Cigna.

She said that at MDLive, the insurer's telehealth arm, the company saw 19% lower duplication of care services compared to in-person providers. The telehealth boom has also helped to reduce unnecessary services, Dodds said.