Don’t Get Burned: What Employers Need to Know About Virtual Healthcare

Do a google search on telemedicine, telehealth, virtual healthcare and virtual primary care and you get similar results from a plethora of providers. As an SME Employer you need to know there are big differences in these providers. Here’s why:

With a major labor shortage in the United States, employers need to utilize every tool available to attract, engage and retain workers. And a new generation of consumers are savvier. They do their research. They compare benefits. The last thing you want to do is offer a virtual care benefit that is not what you think it is, or not what your employees expected.

Virtual PRIMARY Care: The Difference

Here’s what you need to know: Having a virtual primary care doctor is just like having a regular primary care doctor.  A primary care doctor is focused on a patient’s “whole” health. Rather than being transactional, it is relational. Under the best circumstances a primary care doctor builds a relationship with the patient over time and uses their personal knowledge of the patient and their health history to guide diagnosis and treatment. A primary care practitioner is the central point of care who collaborates with other providers to treat a full spectrum of physical and mental health issues.  In more familiar language, a primary care doctor is known as a “general practitioner.” The difference is that a virtual primary doctor’s care is facilitated by technology that allows for many health problems to be treated virtually, without the traditional doctor’s office visit.  That’s the practical difference between regular primary care and virtual primary care. The virtual distribution model creates efficiencies in the system, provides cost savings and increases the likelihood that patients will seek treatment earlier, leading to better health outcomes.

Fierce Healthcare has a definition that is as good as any out there:

“True virtual primary care provides patients with full mind and body care, inclusive of preventive health, chronic care management, urgent care and integrated behavioral health, as well as continuity of care. Through virtual primary care, patients have one dedicated primary care physician and are able to see that same physician on an on-going basis. This is only possible when the virtual care provider has a fully employed workforce of physicians, nurse practitioners and care coordinators to provide consistent care across patient needs.”

Everything Else: Convenience, Not Comprehensive Care

This definition shows there is a vast difference among the many “telehealth” models that have emerged in the wake of Covid-19. To put it simply, there are virtual primary care doctors, and then there is everything else. The commonality is the use of virtual technologies to interact with patients, whether by phone, video or on-line.

Some of these other telehealth models do require the patient to complete a health history and set up an account, which can have the appearance of creating a relationship with a primary care physician. But the conditions they can treat are not full spectrum. Most telehealth providers are focused on urgent but non-threatening health issues. The most common conditions treated are the flu, infections, anxiety, stress and skin conditions. They also may provide consultations on serious medical conditions, which is likely to mean they recommend seeing a doctor in a traditional setting. They do not operate within a network that includes specialists and a care team, even if you can see the same doctor for each visit. The bottom line is while there may be various nuances to each telehealth service, they do not function like a primary care practitioner, and have limits on conditions they can treat and medications they can prescribe. While being on-call 24/7 is a great convenience feature, it does not constitute primary virtual care.

The Advantages of Fixed Indemnity Coverage that Includes Virtual Primary Care

The advantages of offering a primary virtual care benefit are numerous.  If you are an employer under the ACA  mandate, offering a major medical plan that provides coverage for real virtual primary care, that is a start.  But if you employ a lower-wage workforce, there still remains the problem of astronomical deductibles under ACA-compliant plans. This is why a fixed indemnity benefit is a natural supplement to help with these high-deductibles and co-pays. A well-designed indemnity plan is a necessity to help your employees cover these costs, and now should include coverage for virtual primary care. Below are the basic questions you need to ask your broker or any provider peddling a supplemental medical benefits plan that includes telehealth coverage:

  1. Are the doctors in the network dedicated to providing an on-going relationship with the patient that includes continuity of care?
  2. Does the relationship include a care team to address whole health needs?
  3. Does the practice / solution include a referral network of specialists that have a relationship with the primary care providers?
  4. Can your doctor treat the same conditions and prescribe medications, the same as an on-site general practitioner?
  5. Can your doctor order lab tests and get the results?
  6. Are you able to provide your employees a better price than they can readily get on their own?

A Word of Caution

Employers need these answers in order to provide the most value for a telehealth benefit. Plus—and this is very important—offering a benefit that your employees can easily purchase online, as a retail product, (which is most “telemedicine”) is not adding value for you as an employer. As a word of caution, if you attempt to portray it otherwise, it can backfire. A new generation of workers are looking for authenticity and transparency, and that goes to employee benefits too.

Summary: It’s About Recruiting and Retaining Employees Who Are the Lifeblood of Your Business

Covid accelerated the adoption of virtual healthcare and it is becoming a “must have” for healthcare consumers. So, now is the time to add a virtual care benefit that provides real value for employees. When you add this benefit to your arsenal under an indemnity plan, it doesn’t need to cost you anything. Not only does virtual primary care provide convenience for employees, but it can also mean less down time due to employee doctor’s visits and illnesses, better health outcomes, more job satisfaction and real recruiting advantages.

 

By: J. Marshall Dye – Founder and CEO of Insurance Applications Group

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