Health plans

Virtual health plans should worry us all


The use of telemedicine has exploded during the pandemic, transforming healthcare into a convenient alternative to in-person visits. Telemedicine can provide patients with increased access to preventive care and services as well as an integrated digital experience. This was certainly a welcome and long-awaited development for both patients and clinicians.

But now some health insurance companies are using telehealth technology for all the wrong reasons: to limit access to doctors, tests, and in-person visits. These new offerings are called “virtual health plans” and they should be of concern to all of us.

Virtual health plans take a variety of forms, but all encourage (and sometimes require) video tours before you meet with a clinician or undergo an in-person test or service. In some cases, this online gatekeeper is a doctor the patient has never met and will never meet in person. Insurance giants such as Aetna, UnitedHealthcare, Cigna, Humana, Kaiser Permanente, and Oscar have all recently introduced versions of virtual health plans. Many virtual plans attract consumers with lower premiums and cost sharing.

Of course, telemedicine, as a clinical tool, can highlight the best attributes of our health system: increased efficiency, immediate care and, in the best case, concierge service. Telehealth can eliminate emergency care and even emergency room visits, provide better access to specialists, and help chronically ill patients manage their conditions with fewer trips to the doctor. And virtual health plans that use a digital platform to unify a patient’s care could deliver great value – 24/7 access, lab integration, pharmacy integration, lower costs, and focus on patient care. primary care.

But virtual health plans that use telehealth as a gatekeeper – before other care is available to a patient – are very different. This delivery structure actually takes the worst attributes of our health care system – disconnected care, limited patient choice and injustice – and puts them front and center.

For starters, many insurers with virtual health plans hire outside companies to provide medical staff online. In many cases, this is not a problem. But in some cases, these doctors are strangers to all the doctors who treat this patient in person. Worse yet, these third-party vendors often have their own medical record systems, making it difficult to share data. It divides a patient’s care into silos, exactly the kind of inefficiency that technology should solve, not make it worse.

Virtual health plans also present serious equity issues. Thirty-two million Americans do not have the digital literacy to use a computer. A third of those Americans are seniors, but digital illiteracy is also common among people of black or Hispanic descent with lower incomes and education. Four in ten adults with incomes under $ 30,000 do not have broadband services at home, or a desktop or laptop computer. Thirty-one percent of rural areas do not have broadband access. And although they are less well known, many low-income urban areas do not have this access either. A health plan that requires the initial use of a video visit to access in-person care could largely deny in-person care to people with technical or other barriers to telehealth.

The online gatekeeper approach to virtual health plans sounds awfully familiar to people who experienced healthcare in the 1990s. Back then, insurers were forcing patients and physicians to participate in tightly-controlled HMOs, which considerably reduced the choice of patients. The aim was to control rising medical costs, and 51 percent of occupational health insurance registrations were in HMOs in 1998. Consumer backlash was strong, with many plans accusing of providing inadequate access to services and calling for increased regulation. Even so, HMOs have never lost substantial market share, especially in high cost areas of the country. Virtual health plans could have a similar trajectory.

As the head of an independent nonprofit hospital deeply connected to our community that was affected early and hard by the pandemic, I know technology is a tremendous clinical tool in lowering barriers to care. I hope it will become a regular place of care for many patients.

But don’t confuse virtual care with a virtual health insurance plan. Technology builds walls as easily as it demolishes them.

Kathleen Silard is President and CEO of Stamford Health in Stamford, CT.