BY DAVID BOTTOMS, REBC, RHU, CLU, CHFC
SENIOR VICE PRESIDENT, BENEFITS
Published: May 2021 Cobb Business Journal
Over the course of the past year, and by virtue of necessity given COVID-19, healthcare consumers have gotten a crash course in the use of telehealth platforms to engage with healthcare providers via virtual means.
During the early days of the COVID-19 pandemic, as lockdowns were in full effect and even many doctor’s offices were shuttered, telehealth utilization soared such that, per health records company, Epic, 69% of physician “office visits” during the month of April 2020 took place via a virtual care platform.
In the months that have followed, virtual visit utilization has dropped; however, it still stands well above pre-pandemic levels which raises an important question of what role telehealth will have in the United States’ healthcare delivery system in the years ahead. The answer to this question is an important one for health care providers, insurers, and employers who are charting their respective strategic courses for the years ahead.
For healthcare providers and systems, an integrated and effectively marketed virtual care platform has the potential to increase engagement with patients while enabling the health system to ensure continuity and coordination of care within its own healthcare ecosystem which has obvious downstream financial benefit for the provider while also providing efficiencies and improved health outcomes for patients given that, with an integrated, provider-based platform, there is the potential for consistency of provider/patient relationships, electronic medical record maintenance, etc.
For insurers, telehealth has potential to introduce a newfound efficiency to the health care delivery system. Whereas health care providers will be inclined to push their own telehealth platforms so that that they can retain control of data and downstream referral activity, insurers, for their own reasons, see telehealth as an opportunity to integrate their own preferred telehealth platforms directly into health plan designs to reduce incremental “office visit” costs while providing opportunity for referral management and steerage to lower cost, high quality providers for specialty and procedural care in an effort to reduce overall health care spend.
In fact, one needs to look no further than the growth of “virtual-first” health plans to see how insurers such as Humana, United Healthcare and other well-known players are positioning themselves to play a significant role in the front-end of the healthcare delivery system. In these programs, members have access to no-cost virtual care for initial, non-emergency provider discussions and, based upon the referrals from the virtual care physician, can then seek in-person care from in-network specialists for more complex issues, lab testing, etc. In effect, these plans effectively reintroduce the “gatekeeper” role that insurers have historically played in an effort to develop lower cost coverage options for individual health care purchasers and employers sponsoring group benefit plans.
Of course, telehealth has its limits. For pediatric care, the lower potential for patient communication among other obvious limiting factors renders telehealth often less than ideal for children which is reinforced by the fact that, in 2020, only 13% of virtual care visits were for patients under the age of 18. Similarly, on the other end of the age spectrum and given the increased prevalence of chronic health issues and comorbid conditions in older adults, telehealth has its limits which again is validated by the fact that only 18% of telehealth visits in 2020 were for adults over the age of 50.
Nonetheless, younger adults, who just so happen to comprise a significant share of the covered demographic within employer plans, have proven themselves very willing to make use of telehealth resources as evidenced by the CDC’s data which showed that an outsized 69% of 2020’s telehealth utilization was for patients aged 18 – 49 years of age.
The disruptive impact of COVID-19 has accelerated the pace of change in many industries and impacted consumer behavior in a myriad of ways. Health care providers, insurers, and employers would be wise to keep their eyes on the signals consumers are sending with respect to virtual health care preferences and calibrate their strategies to align lest they find themselves outmaneuvered by competitors more acutely focused on this new frontier.
View article in Cobb Business Journal.