Update on Virtual Care: Utilization Surges During the Pandemic

From a health care benefits perspective, the COVID-19 pandemic isn't only about helping employees with the diagnosis, treatment and prevention of the virus in question. It's also about the acceleration of a trend that started long before anyone started talking about "flattening the curve."

Illustration of a smartphone displaying a female doctor on a virtual phone call

That trend is "virtual care," now a broad term used to describe all the ways that health care providers can interact with patients using remote technology. It falls under the umbrella of "telehealth," which refers to the total provision of patient care — from preliminary evaluation to chronic disease management to preventative care — via that same technology. Also under this umbrella is "telemedicine," a word referring to the remote treatment of a specifically diagnosed illness or condition.

Recent survey data indicates employers that have experienced a spike in the utilization of virtual care benefits during the crisis expect that these services will play a larger role in health care even after the pandemic has subsided. Indeed, a Gallup consumer survey in mid-May found 27% of respondents reported that they'd received care virtually while less than half of this percentage (12%) received such care in late March. And according to Fair Health, a virtual care data tracking organization, virtual care claims jumped by 4,347% from March 2019 to March 2020, when the pandemic hit the United States.

"Health care is never going back to the way it was before," prominent health economist and former Medicare chief Gail Wilensky recently said.

Survey Says

Top health benefits consultancy Mercer concurs. "While the pandemic has created immense public health challenges, it has also revealed significant opportunity for employers to transfer the role of virtual care and make it central to future benefit strategies," the company has stated.

Employers' recent experience with virtual care has been almost entirely positive, according to Mercer's research. Two-thirds of employers whose employees have used virtual care in response to the pandemic expect it to become a "permanent fixture" in their workplaces. In the same survey, 43% of employers who had enough data to assess satisfaction with their virtual care providers were "very satisfied." The rest, aside from a disappointed 1%, report being "satisfied."

Nevertheless, employers need to think carefully about how they plan to use virtual care to avoid adverse unintended consequences, such as potential overutilization of health care services. This includes those yet to jump on the virtual care bandwagon.

Overcoming Inertia

For a variety of reasons, some physicians have been as reluctant to embrace virtual care as many patients have —at least before the COVID-19 crisis. Sluggish inertia was part of the problem, but pandemic-inspired stay-at-home mandates left many physicians and patients with little choice but to use virtual care. This has built momentum.

Physicians' willingness (and in some instances, authority) to deliver care virtually was further enabled by the easing of emergency restrictions on how they can care for Medicare patients. One Medicare change enabled physicians to charge the same fees for specific procedures regardless of whether they're provided in-person or virtually. Another dropped a requirement that a physician establish a relationship with a patient before providing virtual care.

It's possible that elements of the policy change will prompt easing of some state-level limits and medical profession practice guidelines on how care can be provided for private patients.

Land of Opportunity?

The top two diagnoses involved in virtual care both earlier this year and a year before were mental health conditions and acute respiratory diseases and infections. Physicians and other observers are increasingly recognizing multiple potential benefits of virtual care beyond seeing patients who are fearful of leaving their homes. The American Medical Association ticks off the following opportunities:

Of course, embracing virtual care doesn't guarantee any of those outcomes. To achieve any of them, Mercer argues, employers must "actively manage their digital strategy." If they don't, they'll "be at the mercy of the market."

Active management means focusing on several key variables for success. One is that the health care service — whether it's a virtual primary care visit, counseling session or smoking cession class — provide the same high-quality experience "often seen in consumer applications," according to Mercer.

Focus on Primary Care

It's also important to build virtual care systems on a foundation of primary care physician (PCP) relationships. Many of your employees may not have such doctors — especially younger ones. Nearly half of millennials (45%), for example, don't have a relationship with a PCP, according to Mercer. The convenience of quick access to a PCP through a virtual care arrangement "could be a game-changer, prompting more PCP interactions and thereby increasing early identification of health issues and care continuity," Mercer believes.

But encouraging use of health care resources via virtual care can also lead to overutilization. Mercer cautions that, as virtual care gains greater acceptance, "plan design will need to promote efficient, appropriate utilization with incentives that drive quality and value" — just as it should without virtual care.

Finally, value is what you get for your money. Charges for virtual visits and in-person visits are typically the same right now. "Ultimately," Mercer advises, "pricing needs to be aligned with the efficiencies of virtual care or it will break the bank for employers and employees."

Critical Role

Virtual care is no longer the wave of the future. That wave has made landfall and is rapidly working its way into the mainstream, partly because of circumstances created by the COVID-19 pandemic. As your organization evaluates its current health care benefits and considers plan design changes, assess the critical role that virtual care may play in keeping your employees healthy.

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