The integration of virtual care into healthcare systems is becoming increasingly important, and payers play a crucial role in this transformation. The article on MedCity News discusses the challenges and opportunities for payers in adopting virtual care providers, emphasizing the need to address technological, procedural, and regulatory roadblocks.
Key points from the article include:
- Growth of Virtual Care: Virtual care has seen considerable growth, now accounting for 14-17% of patient visits, up from about 1% in February 2020. This growth has been constrained by various barriers, including technology, procedural, and regulatory issues.
- Payers at the Epicenter: With 76% of physicians citing a lack of insurer coverage as a major barrier to effective telehealth delivery, payers are at the center of the healthcare transformation. They are crucial in driving the adoption of virtual care providers and bridging the gap between innovation and patient access.
- Challenges for Payers: Payers face specific challenges in integrating virtual care into their networks. These include outdated systems based on zip codes, regulatory and policy constraints, and concerns about network abrasion and steerage.
- Outdated Systems: Health plans’ policies and systems, traditionally built around in-person healthcare delivery, struggle to integrate virtual-first provider organizations. For example, zip code-based ‘find a doctor’ tools are ineffective for virtual clinics serving large geographic areas.
- Regulatory and Policy Constraints: Providers and payers face regulatory barriers, such as state licensure requirements and state regulations, which add administrative costs and barriers to scaling care. Additionally, network adequacy policies have not been updated to reflect the capabilities of virtual clinics.
- Network Abrasion and Steerage Concerns: Health plans introducing virtual care providers must navigate concerns from large health systems and provider groups about virtual care being a competitive threat. Complex anti-steerage clauses in contracts also limit health plans’ ability to promote new provider options.
- Progress and Innovation: Despite these challenges, there are promising initiatives aimed at fostering payer engagement with virtual care providers. Insurers are establishing digital front doors for members, enhancing accessibility to care, and making significant investments in virtual care.
- Future Outlook: The article suggests that the future of healthcare lies in the convergence of technology, collaboration, and patient-centricity. Payers, as catalysts for change, must address the technological, procedural, and regulatory roadblocks head-on to unlock the full potential of virtual care providers.
In summary, while there are significant challenges in integrating virtual care into payer networks, there are also opportunities for innovation and improvement. Payers are key to driving this transformation, and their actions can significantly impact the accessibility and effectiveness of virtual care in the healthcare system.