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Four capabilities health plans are looking for in a virtual-first primary care partner

Virtual primary care products enable health plan members to seek primary care with a dedicated virtual provider via video visits or messaging. These products are often integrated with virtual behavioral and urgent health care, as well as in-network referrals to in-person specialists. Following the peak of Covid-19, virtual primary care is still growing in popularity with CVS Health the latest national plan to announce a new virtual primary care solution.


Three partnership models exist for health plans looking to roll out a virtual-first primary care

1. Buy or build: The first model involves acquiring a telehealth vendor or building out the capability entirely in-house. A few health plans with the resources to do so have chosen this route—one example is Cigna, who acquired telehealth company MDLive for their virtual-first plan.

2. Traditional provider networks: The second model is to bring traditional provider networks into a virtual setting. This choice allows members to stay with their current provider. However, many health plans have not chosen this model for their virtual primary care products for several reasons. Traditional provider networks often don’t have the technology capabilities that plans need for these products, and they may not align with the plan’s goals to keep in-person referrals low-cost and in-network. Also, some providers still believe virtual care is lower quality or harder to use.

3. Telehealth vendors: The third model is by far the most common among health plans: contracting with telehealth vendors. These companies are built for virtual primary care from the ground up, furnishing an array of telehealth services for plan members—as well as an infrastructure to facilitate follow-up, downstream utilization.

Advisory Board interviewed plan leaders to uncover the key capabilities that plans should be asking for in a virtual primary care partner. Below are two must-haves that plans require from telehealth vendors, as well as two differentiators that can put vendors ahead of others. We’ve also included vendor examples to bring these characteristics to life, but Advisory Board remains vendor-agnostic and does not recommend or endorse the vendors discussed below.


Two must-haves in a virtual primary care partner

The following are two non-negotiables that plans should ensure virtual primary care vendors bring to the table.

1. Sophisticated digital architecture

Digital infrastructure is the backbone of telehealth products. But more important is the way that digital components are designed: their architecture. Telehealth vendors must go beyond sheer functionality to design their products with consumer experience and provider efficiency top of mind. For a stand-out consumer experience, plans are looking for an easy-to-navigate app, provider profiles and self-scheduling, accessible benefits, and cost information. In terms of provider efficiency, plans also want integrated electronic health records, provider-to-provider data sharing, and dependable virtual visit platforms.

Vendor example: Carbon Health is a virtual care provider equipped with an innovative app and website. Members have full access to their medical history, provider profiles, and same day scheduling through this platform. Providers, in turn, value Carbon’s proprietary electronic health record, messaging, and video systems. With the help of this technology, Carbon boasts a 92% acceptance rate when offering roles to clinicians.

2. Accessible, whole-person care

A major perk of virtual care is accessibility: members can seek care from a breadth of providers without travelling to different brick-and-mortar facilities. This accessibility enables whole-person care, where a team of providers can give members many different forms of care at once. In practice, plans should seek out telehealth vendors who offer a large network of virtual primary care providers, in addition to urgent care, behavioral health, and wellness programs. These vendors can also increase equitable access by connecting patients in rural areas with virtual PCPs or connecting patients of color with virtual providers who look like them.

Vendor example: Firefly Health, a virtual-first health care delivery system, offers whole-person care by assigning each member a primary care physician, a behavioral health specialist, a nurse practitioner, and a health guide. These practitioners collaborate to help improve clinical outcomes and manage chronic conditions – Firefly claims 76% of their hypertension and diabetes patients are in control.


Two ways virtual primary care vendors can differentiate themselves

The following are two main ways that telehealth vendors can differentiate their products. Forward-thinking plans have started to ask virtual primary care partners for these offerings.

1. Care navigators and concierge services

Virtual care navigators are uniquely positioned to improve member experience at almost every touchpoint of the care journey. Beginning with onboarding and scheduling care, they can help members become acquainted with the new technology and choice of providers. Following care, they assist with transitioning to in-person specialty care, navigating treatments, or understanding billing and benefits. Above all, they serve as a liaison between providers, members, and the plan. Plans should recognize that digital care navigators or concierge services maneuver the complexities of hybrid care in a way that is unmatched by traditional provider organizations.

Vendor example: Accolade offers virtual primary care for employers nationwide. Their health assistant program is a defining feature of their services—it pairs each member with a personal health care concierge they can call at any time to get help with scheduling, billing, or general care navigation. Accolade boasts that they assist 70% of members prior to any care delivery and 90% of patients with complex conditions.

2. Seamless transition to in-person care

Virtual primary care products are well-equipped to address a variety of care needs, but they can’t do it all. One of the largest challenges confronting virtual primary care involves the transition from virtual to in-person care. During this exchange, all stakeholders have unique needs—members require an accessible in-person provider, virtual providers must exchange visit information with their brick-and-mortar counterparts, and health plans hope to guide the member towards high-value, in-network options. This transition remains a challenge for telehealth vendors and provider networks alike, although vendors who have optimized this transition are well-suited to distinguish themselves to plans.

Vendor example: Included Health, formerly known as Doctor on Demand, is one vendor that boasts its transition from virtual to in-person care. When necessary, they work with plans to refer patients to in-network, in-person care via their website or app. Virtual primary care providers are also able to send information to in-person providers and vice versa. They claim a 60% increase in visits to top quality providers through this referral system.


Parting thoughts

Vendor partnership or acquisition is becoming the status quo for plans looking to roll out a virtual primary care product. Here’s what different stakeholders should do for next steps:

1. Health plans: For those with a virtual primary care partner, ensure that your chosen vendor offers some combination of the above capabilities. If they don’t, talk to them sooner rather than later as members begin to ask questions or consider switching plans. For those without a virtual primary care solution but considering one, don’t rush to partner with a vendor. Find one that addresses all the capabilities above and fits your membership.

2. Telehealth vendors: At a minimum, offer the two must-have capabilities above. Also, look to further distinguish your products by leveraging digital providers or expertise as the last two examples show. If you already have these features, make sure you’re communicating these differentiators clearly to current and potential plan partners.

3. Traditional provider networks: Competing in the virtual primary care space requires balancing virtual and in-person care. Take note of the above capabilities and make sure physicians are fully onboard with the requirements of virtual care if you want to partner with plans on a virtual primary care product.

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