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 encourages video visits - or outright insists on them.
"I would describe them as virtual first, a true telehealth primary care physician replacement product," said
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.
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 patients never meet their online doctor in person.
Many insurers offering virtual-first plans hire outside firms to provide medical staff. The physicians may hold licenses in several states and not be located nearby. Insurers say participating online doctors can access patients' medical information and test results through the insurers' electronic medical records system or those of the third-party online staffing firm. What might prove tricky, experts warn, is transferring information from physicians, clinics or hospitals outside of an insurer's network. Sharing patient information via EMRs is challenging even for doctors operating under traditional insurance plans with in-person visits - especially moving data between different health systems or specialty practices.
The virtual-first concept was so new that
Other versions of telehealth plans are available, offered by big names such as Humana,
Oscar Virtual Care health plans, sold in several states including
"These are not virtual-only plans," said
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 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
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.
Skeptics note that many circumstances demand in-person care. One recent study estimated about 66% of primary care visits required it. For example, it's impossible to check reflexes and difficult to examine tonsils for infection virtually.
Patients in some programs, including Harvard Pilgrim's, are sent kits that can include devices like blood pressure cuffs and thermometers - though at-home medical measuring devices are often not as accurate as those used in offices. Online physicians may also ask a patient to feel for swollen lymph nodes, shine a light into their throat while on camera or take other actions to help the physician diagnose a problem .
"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
Patients incur no copay for using online
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 are not 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."