At the height of the COVID-19 pandemic, people often relied on telemedicine for doctor visits. Now insurers are betting that some patients liked it enough to embrace new types of health coverage that encourage video visits—or that outright insist on them.
Priority Health in Michigan, for example, offers coverage requiring online visits first for nonemergency primary care. Harvard Pilgrim Health Care, selling to employers in Connecticut, Maine, and New Hampshire, has a similar plan.
“I would describe them as virtual-first, a true telehealth primary care physician replacement product,” said Carrie Kincaid, vice president of individual markets at Priority Health, which launched its plans in January as an addition to more traditional Affordable Care Act (ACA) offerings.
The often lower-premium offerings capitalize on the new familiarity and convenience of online routine care. But skeptics see a downside: the risk of overlooking something important.
“There’s a gestalt of seeing a patient and knowing something is not right, such as maybe picking up early on that they have Parkinson’s,” or listening to their heart and discovering a murmur, said Dr. David Anderson, a cardiologist affiliated with Stanford Health Care in Oakland, California. He said online medicine is a great tool for follow-up visits with established patients but isn’t optimal for an initial exam.
When enrolling in one of the new plans, patients are encouraged to select an online doctor, who then serves as the patient’s first point of contact for most primary care services and can make referrals for in-person care with an in-network physician, if needed. It’s possible that patients may never meet their online doctor in person.
The virtual-first concept was so new that Priority Health called those enrolling this year to ensure they understood how it worked.
“If people were more comfortable with brick-and-mortar, they should choose other options,” Kincaid said, adding that the plans have drawn 5,000 enrollees since January, a number she hopes will double next year.
Other versions of telehealth plans are available, offered by big names such as Humana, Kaiser Permanente, Oscar, and UnitedHealthcare. Some emphasize but don’t require that primary care starts online. Some are aimed directly at consumers. Others are sold to employers.
Oscar Virtual Care health plans, sold in several states including Texas, Florida, and New York, allow patients to choose between online or in-person services.
“These are not virtual-only plans,” said Marianna Spanos, an Oscar vice president and the general manager of its virtual care division. “You can always opt to see a more traditional provider.”
Although Kaiser Permanente uses its own in-house medical staff, most insurers rely on contracted physicians, mental health therapists, and other staff members, often provided by San Francisco-based Doctor on Demand.
Doctor on Demand launched in 2013, aimed at individual consumers. Starting with a Humana contract in 2019, it has since expanded to offer staffing for several other insurers. The company, which has its own electronic medical records system, hires a range of primary care, mental health, and other medical providers. Physicians must be board-certified. Pay is partly based on how many patients they see, and there is no upper limit. Some want to work part-time, for example, and many work from home.
In general, virtual-first health plans may carry lower premiums or provide such financial incentives as no copays for online visits. All boast that members can get appointments quickly, sometimes within minutes. Patients with serious problems are assisted in arranging emergency help. If online physicians determine that patients need a blood test, immunization, or a visit with a specialist, they refer them to a local practice, clinic, or specialist within the insurer’s network.
As a strategy to contain costs, think HMO 2.0.
“There’s more control over the patient interaction and where they get referred,” said Sabrina Corlette, a research professor and co-director of the Center on Health Insurance Reforms at Georgetown University.
Still, patients should be aware that some of these plans may allow a brick-and-mortar visit only if their virtual doctor, who may have never examined them in person, deems it necessary.
Kincaid, at Priority Health, noted that Doctor on Demand also sets protocols on children’s wellness visits, which it says must be done in person.
“It’s important for children’s wellness visits to get accurate height and weight measures and immunizations,” Kincaid said.
When considering virtual-first plans, advocates say, patients should look closely not just at premiums but also at deductibles and copayments, which may be set at levels that discourage in-person care. Rules are varied and dizzying.
The VirtualBronze plan offered through the federal ACA marketplace in parts of Texas by Community Choice Health, for example, requires hefty patient contributions for many types of in-person visits.
Patients incur no copay for using online Doctor on Demand physicians for primary care visits or for accessing in-person preventive services as defined by the ACA, such as immunizations or cancer screenings. But for other in-person services, Community Choice’s virtual plan will cost patients out-of-pocket because they pay the cost of the care until they meet an annual $8,530 deductible.
Plans sold through federal or state marketplaces and those offered by employers must meet the ACA’s requirements. That includes a range of services, from doctor visits to hospital care.
Corlette, at Georgetown, said consumers should be wary of plans that aren’t ACA-compliant.
She fears the advent of plans that give patients “access to online providers, but nothing else.” And that, she said, “would not be considered major medical insurance.”
