By Ami Parekh
A mean telehealth safe harbor rule hiding in a beautiful bill is a major milestone in virtual care. Although it is specifically targeted at telehealth services in deductible telehealth programs, the legislation has a greater impact on care delivery and insurance design, especially in the commercial insurance market. In fact, the permanent extension of policy in the era of pandemic makes it clear to health insurance companies that a new era of virtual care is underway.
The provision permanently expands policies in the era of expiration and is a victory for employers and workers. After five years of uncertainty, employers are now authorized to provide telehealth services to their entire staff at little or no cost, which has been proven to reduce access barriers and close care gaps. Especially for self-funded employers, this cost-sharing flexibility – coupled with an increasingly complex ecosystem of virtual care providers – will further accelerate innovations in welfare strategies and workforce well-being.
Less obvious, this employer-led innovation is also changing the virtual care environment of key partners: health plans. Although 20% of employers contract directly with professional telehealth providers, 78% rely on their health plan partners- and Their Supplier – Provide telehealth services to employees. Sanitation plans have a significant seat on the dining table as employers revisit their long-term virtual care strategies with new assurances after safe harbors are offered.
However, the seat is heating up. In a year when employers are expected to increase health care costs by more than 9%, employers are reviewing their partnerships and program designs to ensure virtual care solutions bring meaningful value to employees and the bottom line.
In the New Year survey by Health Business Group (BGH), more than three-quarters of employers said they are actively eliminating underutilized programs and underperforming suppliers, or are considering doing so. Employers have also raised RFP expectations, assessing an increasing list of factors and capabilities, including performance assurance, product and network design, reporting and analysis, and member experience, including an increasing number of factors and capabilities.
In view of this, the provisions of the Safe Harbor are a call for health plans to evaluate their own virtual care strategies and partnerships through the employer’s lens. Three areas are particularly important:
1. quality
In the BGH survey, employers will introduce navigation to high-quality providers with a focus on improving quality transparency – virtual care is no exception. In last year’s survey, half of all employers expressed concern about the quality of virtual care.
Like physical providers, the quality of virtual care varies greatly between organizations and individual clinicians. However, the quality framework for virtual care has not kept up with the rapid expansion of technological advancements and use cases. Now that virtual care is fully integrated into care services and patient experiences, healthcare buyers including employers and public sector organizations, as well as health plans, needs to modernize how they evaluate the quality of virtual priority providers. Key issues include:
- How do providers ensure their clinicians follow clinical guidelines?
- How strict is the clinician certificate process?
- Does the provider network include expertise in high-demand specialties such as puberty mental health that are facing acute provider shortages?
- Have an approved quality management plan been formulated?
- How do providers evaluate key measures in areas such as chronic condition management and care continuity?
As virtual and hybrid care becomes the norm, buyers need to start evaluating all There are the same strict provider regardless of the setup.
2. integrated
The prosperity of telemedicine has been a double-edged sword over the past decade. While the market offers more options than ever before, a large number of solutions have become overwhelming for welfare leaders and employees. In fact, virtual care has become as isolated as traditional health care. Nearly 60% of employers see the lack of integration between virtual care solutions as a challenge.
Leading virtual priority providers go beyond the narrow and transactional care that defines telehealth 1.0 ERA, breaking silos by building a network of physicians across urgent care, primary care, behavioral health and professional care, including experts in traditional hospitals and health systems. It is crucial that virtual priority providers should have high-quality EHR with clinicians who meet in person, so that continuous health care is available in all cases.
Just like our streaming services on our phones and TVs, people and buyers don’t want to spread (underutilize) applications and subscriptions from more than a dozen different providers. They want a core suite of services that are tailored to their needs in a one-time, cohesive experience. Health programs are making integration and consolidation possible.
3. Innovative plan design
Employers seeking to dominate costs are doubling over alternative planning designs to inspire high-quality, high-value care. In the recent McKinsey report, more than 85% of employers consider value-based models to express strong interest in flexible co-payments and a no-deduction program – exactly the types of flexibility and innovation that the safe harbor legislation is designed to encourage.
Low-cost and cost-free virtual care has proven to be a powerful lever for improving clinical and financial outcomes. For example, in 2020, Walmart, the largest private employer in the United States, worked with including Health (I serve as Chief Health Officer) to test the impact of providing its colleagues with $0-Opay Virtual primary care as well as low-cost virtual therapies and psychiatry, with approximately 50% of primary care providers not having established primary care providers. Over the next three years, a case-control study found that integrated services narrowed the gap in care, with reduced emergency medical visits and hospitalizations reducing total care costs by 11%.
Walmart’s example highlights how innovative approaches to design and cost sharing are planned, as well as integrated and vertical virtual care, can remove traditional access barriers and direct employees to high-quality care that they cannot always get in physical settings. With the momentum of this trend, health plans and service providers focusing on value-based virtual priorities models will be strategic.
A new era of virtual care
The Safe Harbor regulations emphasize virtual care that will be left behind. But with the endurance brings new challenges and increased expectations. As employers and workers increasingly seek broader needs and services, health programs and their virtual care partners will need to work harder to anticipate these needs, provide high-quality integrated services, and explore new ways to improve access to high-value care. Those who don't meet this moment may find themselves at sea.
Ami Parekh is the chief health care officer including health.
