A health plan administrator thinking about telehealth services might envision a member making a late-night call looking for ear pain relief or hoping to avoid an ER visit with a feverish child. But telehealth has evolved beyond basic urgent care assistance. Today’s comprehensive virtual care is being used to improve outcomes, reduce the impact of expensive, unnecessary and ineffective care and even support payer-provider collaboration.
Comprehensive virtual care addresses the biggest healthcare challenges of our time, primarily access to quality care across populations and its value within the healthcare ecosystem. Whether on its own, or in conjunction with more traditional care, a comprehensive virtual care strategy can include a range of expert medical services to support the identification and management of complex conditions, even those with behavioral health components or chronic pain, GI conditions, cancer and more.
Members with conditions like these — that are often difficult to diagnose and identify cost-effective treatment for — benefit from a broad and comprehensive virtual care strategy. This represents a necessary strategic shift for health plans charged with navigating our costly, and increasingly complex, healthcare system. Building member-centric virtual services allows health plans to better serve their clients and plan members, in three ways:
1) Reduce expensive, unnecessary and ineffective care.
An expert medical review is proven to reduce the use of high-cost settings such as ERs, surgical centers and urgent care facilities. Teladoc Health’s comprehensive, claims-based study, performed with a large health plan that utilizes their Complex Case Consult service, demonstrates how this type of expert medical review reduced utilization of acute-care and high-cost settings between 25 percent and 34 percent.
Expert medical reviews may also include a recommendation for lower-cost medications with similar efficacies. Overall, according to the Teladoc Health study, patients who adhered to expert recommendations saw a per-case savings of approximately $36,000. When patients did not follow the recommendations, costs were five times greater.
In one specific case, a 65-year-old diagnosed with ulcerative colitis lost more than 40 pounds in a year, despite trying a variety of medications and therapies. Then, when she was later diagnosed as also having Crohn’s disease, the number of medications further increased with no improvements. The team of experts at Teladoc Health carefully reviewed her case and confirmed her diagnosis of severe ulcerative colitis. However, during their review they discovered that she did not actually have Crohn’s disease. Armed with this information, she followed a treatment plan recommended by Teladoc Health which included the elimination of expensive biologics. By focusing on the correct diagnosis and avoiding unnecessary and potentially harmful medications, her condition improved significantly and the cost avoidance for this case totaled nearly $100,000.
2) Improve outcomes.
Who you know and where you seek care often determines your health outcomes, but virtual care can level the playing field. The son of a prominent health plan’s CEO became ill with ongoing, debilitating, undiagnosable headaches. Because of his position, the CEO was able to bring together top experts from nearby healthcare organizations to review his son’s records. Together they discovered he was suffering from symptoms as a result of exposure to black mold. With this accurate diagnosis, his treatment path became clear and his condition was successfully managed.
“Not everyone has the same access to top-notch healthcare as the CEO of a prominent health plan. Until he pulled together the right experts, who sat down and comprehensively reviewed the information, they could not figure it out,” says Chad Baugh, vice president and general manager, complex case management, at Teladoc Health. “Comprehensive virtual care consistently and equitably delivers this level of expert care.”
Virtual expert medical services improve outcomes by granting equitable access to expert care for complex, costly conditions. This type of coordinated treatment improves members’ quality of life, increases their understanding and confidence in their diagnoses and in their treatment plans. As a result, the negative impact of these types of complex conditions is reduced for the member, for their loved ones, and for an already over-burdened healthcare system.
3) Support payer-provider collaboration.
In today’s churn-and-burn healthcare system, PCPs and other physicians in a fee-for-service model are not incentivized to take the time to think through the complexities of challenging cases and optimize care. In contrast, an integrated virtual approach to complex cases helps to support the provider through effective collaboration, communication and coordination by putting all available member health information front and center from the start.
A clinically collaborative partnership expands the treating team’s capabilities, ensuring everyone makes well-informed medical decisions to provide the best possible care. “We can treat the patient more efficiently and effectively, getting to a better outcome in a shorter period of time. And we’re able to reduce readmissions,” says Lawrence Swink, MD, a primary care provider at Columbia Medical Practice in Columbia, MD. As part of a large Patient-Centered Medical Home (PCMH) using Teladoc Health’s expert medical review service, Dr. Swink realizes value from the support he receives identifying and managing complex cases during his day-to-day practice of medicine.
According to the Deloitte 2018 Surveys of US Health Care Consumers and Physicians, consumers are most drawn to the convenience and access of virtual care (64%), while physicians are motivated by how it improves access to patient care (66%). Overall, virtual care helps competitive health plans to be more strategic in the market while facilitating high-quality care at a lower cost for members and clients.
Health plans are extremely busy utilizing data analytics, evaluating approaches to population health management, developing value-based care and more. “But if you’re looking for an initiative that has defined results with a positive impact, you’ve got to look at virtual care,” says Baugh. “Comprehensive virtual care has the potential to dramatically change our healthcare system.”