A recent survey from Merritt Hawkins shows wait times to see a physician are long, ranging from an average of 29 days in large markets to 56 days in mid-sized markets. Even worse, these wait times have increased by at least 30 percent since 2014.
When members don’t have timely access to appointments for office-based physician services, it is more likely they’ll rely on the emergency department or urgent care clinics for treatment. In many instances, this treatment is for acute symptoms that don’t require the level of intensity of service, resources or cost attributed to ERs and possibly urgent care centers.
The result is a far higher cost to the health system – including out-of-pocket expenses for members and costs borne by health plans – for treatment.
Virtual health care services address this gap in the healthcare system by furnishing on-demand clinical care from high quality, board certified providers licensed in the same state as the member. These services include all of the elements of a traditional physician visit, including assessment of symptoms, examination, and treatment plans that include prescription drug management when warranted.
Members can access virtual health care 24 hours a day, 7 days a week at a fraction of the cost of urgent care or emergency room visits.
For health plans, virtual health care offers key benefits.
First, health plans offering coverage for virtual health care help to divert members in need of acute, non-emergency care away from high-cost settings. Second, the on-demand nature of these services enables members to be more pro-active in the overall management of their own care at a lower cost. In addition, unlike episodic visits in retail clinics, virtual health settings are better equipped to leverage clinical expertise to address more complex clinical cases.
For consumers increasingly used to on-demand access to products and services, virtual care is a natural fit, becoming more of an expectation than a luxury.
“Convenience and acceptability on the consumers’ terms are becoming more important and virtual health is helping to drive that change in expectation,” says Daniel Trencher, Senior Vice President of Product & Strategy for Teladoc.
“Access at a reasonable cost is critical,” Trencher adds. He cites the example of a member who may be waiting in the emergency room in the middle of the night on a weekend. This member is fully aware the visit may cost $2,000, but he/she doesn’t feel like there are any other options.
“When virtual health care services are available, and the health consumer is aware, the result is typically a decline in emergency room utilization for acute, less complicated problems, which aligns with the shared goal of the member and health plan to address the member’s problem at a lower cost,” Trencher says.
However, the value proposition of covering virtual health care services for health plans isn’t only about reducing unnecessary utilization of emergency care services, it is about offering convenient, virtual access to healthcare services as a benefit, according to Phil Colmenares, MD, MPH Senior Vice President and Chief Medical Officer for Premera Blue Cross, based in Mountlake Terrace, Wash.
“If virtual health ends up being a cost savings, I think that’s great.. But the main reason we should be exploring virtual health care is because this type of care is something that a growing part of our membership is increasingly demanding,” Colmenares says.
Colmenares believes that, to date, it’s still an open question whether “first generation” acute care virtual health care services generate consistent cost savings, but highlights the great potential for virtual care to offer high quality specialty care at a lower cost.
“Virtual health care services currently hold more appeal among millennials and younger consumers,” Trencher acknowledges, though Teladoc shows a high satisfaction rate among members of all demographics who try the service.
Many health plans are offering telehealth services today, and technology already allows for the delivery of services that address more complex member care beyond acute conditions. The Teladoc platform not only includes solutions for acute conditions, but it supports the full spectrum of care, including the type of work that needs to be done to chart the best treatment path when faced with a life-changing diagnosis such as cancer. Teladoc’s robust virtual care service offering is rising to meet consumer demand.
“Although not yet the case, it’s clear that in the future, virtual care delivery will become a competitive edge. That’s why we have to start thinking about it and building it today,” Colmenares says.