Three Common Characteristics Among Virtual-First Health Plans

By Kelsey Waddill

Prominent payers have sought to create health plans that are anchored in virtual care, known as “virtual-first” health plans.

The virtual-first health plan is not directly the result of the coronavirus pandemic. The virtual-first approach was certainly a part of the conversation in 2019. In fact, Humana announced its virtual-first health plan or benefit in April 2019, when most of the world had no idea what the coronavirus was.

But the pandemic transformed hypothetical scenarios into immediate realities, driving the health insurance industry at large to take more risks on these technologies. According to the CDC, in the first quarter of 2020 when the pandemic struck the US, telehealth visits increased 50 percent over the amount in the first quarter of 2019.

Even as telehealth utilization return to less extreme levels—dropping from 69 percent of visits in mid-April 2020 to a little over 20 percent of visits in July 2020 according to Epic’s data—the technology remains essential to care.

As an increasing number of payers adopt the virtual-first approach, some consistencies are beginning to emerge from these health plans, namely the aim to provide constant access to care, their focus on primary care, and the decision to supplement virtual-first health plan member engagement with concierge-style support.

24/7 ACCESSIBLE CARE

Community Health Choice recently launched its new virtual-first, bronze health plan on the Affordable Care Act marketplace, called the Virtual Now Bronze 11 Plan.

The primary aim for this health plan is to offer affordable, virtual primary care services to those who are ineligible for Medicaid or Medicare.

“This plan works best for people who are extremely busy and looking for convenience,” the health plan’s website explained. “It allows 24/7 virtual doctor visits, at home or on the go.”

Members have unlimited access to providers through virtual care and they can receive care without any copay. The payer partnered with a telehealth platform to provide this option.

The plan does not only provide primary care services, however. Members can also receive urgent care, preventive care, and support for their behavioral healthcare needs through the virtual care platform. Their healthcare providers may also refer them to in-network specialists and facilities as well as to Community Health Choice programs.

For most of the  Virtual Now Bronze 11 Plans—with the exception of the Zero Cost-Sharing plan—the deductible is $8,550 for an individual and $17,100 for a family and those are the maximum out-of-pocket healthcare spending costs possible, respectively.

“We couldn’t be happier to offer this new virtual plan, improving access to quality, comprehensive care while keeping costs affordable for our members,” said Lisa Wright, president and chief executive officer at Community Health Choice.

PRIMARY CARE EMPHASIS

Oscar announced its new Virtual Primary Care in August 2020 which—as the name suggests—sought to integrate virtual care into the primary care setting.

“Virtual Primary Care is the latest addition to the suite of Oscar Care features that provide a personalized experience for Oscar members,” the press released stated.

In order for providers to make accurate diagnoses, the payer provides Oscar primary care members with a vitals monitoring kit, according to Oscar’s website. The health plan also can send an expert to the member’s home in order to perform lab work. Providers can also prescribe certain medications through Oscar’s virtual primary care.

Depending on the member’s state and other factors, they could receive these services at no cost. The first visit to any specialist referrals from the member’s virtual primary care provider are also free as well as some durable medical equipment and imaging.

The plan also includes access to virtual urgent care. Members may connect with an urgent care provider virtually in as low as 15 minutes through the health plan’s app or online account.

The payer compared costs for routine care between traditional health plans and Oscar’s virtual health care plan. In a traditional Oscar health plan, a doctor’s appointment, blood draw, new prescription, specialist referral, and follow-up appointment could amount to $218. In the virtual primary care plan, however, these services have the potential to add up to $0.

Oscar’s virtual primary care does not take the form of a single health plan. Rather, it is a feature that the payer has incorporated into many of its health plans.

“Oscar’s Virtual Primary Care offerings vary by market and may not be available in your area,” the payer explained.

In fact, Oscar’s virtual urgent care offerings may be more ubiquitous than its virtual primary care offerings.

“Oscar’s Virtual Urgent Care offerings are available on all Oscar plans,” the payer stated. “Oscar members can use Virtual Urgent Care in all 50 states, however it is not available in US territories or internationally.”

CONCIERGE-STYLE SUPPORT

UnitedHealthcare’s virtual-first health plan in California—called the California Doctors Plan—was introduced in September 2020.

UnitedHealthcare, along with other payers, decided to use concierge-style member engagement to support its virtual-first approach.

“To enhance the customer experience, UnitedHealthcare has developed a dedicated service team that provides personalized concierge support for members enrolled in the California Doctors Plan, Signature Value HMO plan and UnitedHealthcare Canopy Health Medicare Advantage plan,” the press release said.

Plan members have zero co-pay for both primary care services and urgent care services. It includes 24/7 access to a provider through the plan’s telehealth platform as well as UnitedHealthcare’s app and the member’s account on myuhc.com.

“In designing the California Doctors Plan, we wanted to not only offer significant cost-savings but also a more personalized, simplified and coordinated care experience that can help people improve their health and well-being,” said Steve Cain, chief executive officer of UnitedHealthcare in Northern California.

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