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As a practicing primary care physician, I see every day just how fragmented our current health care system is, and how hard it can be to navigate. Inefficient programs and processes, such as how we manage patient information, make for serious frustration among doctors and patients alike.
We shouldn't lose hope – there have been some bright spots in our ability to support patients in recent years. Rates of proactive screening have increased significantly, and with tools like in-home screening kits, physicians are catching diseases earlier. But there is more work to be done to ensure the patient experience is at the center of everything we do, and increase access to high quality care.
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While it's encouraging that chronic diseases are being identified earlier, it can be a struggle to manage them consistently across the board. Patients often feel alone in finding ways to effectively manage their symptoms, and end up in the wrong place and without the proper support to sort things out. In many cases, a patient might end up receiving specialty care, or urgent and emergent care, when a primary care provider would have been able to assist with preventative care or treat the patient earlier on. As an industry, our top priority should be to increase access and quality of care, and ensure it is personalized, so patients receive it at the right time, in the right place.
Virtual care can be a solution for helping patients get to diagnosis and treatment faster, but we need to make sure it's not causing further fragmentation.
Not all virtual care is the same – understanding the options
In the past, virtual care has been perceived as a means to episodic care, or after-hours care, when traditional means of receiving care were unavailable. Telehealth usage rose dramatically during the pandemic, because ensuring patient and provider safety drove new modes of reaching doctors for all kinds of support. Telehealth remains a valuable option for consumers, and as virtual care options expand, it has become crucial for employers to continue to provide access for their employees. What matters now is choosing quality virtual care options that can meet each individual's needs and improve their care experience.
Until recently, telehealth offerings varied widely – behavioral health care might be available through one avenue, while urgent care options could look completely different. Often, employers have been the ones to try to cobble together multiple point solutions for a cohesive program. In a way, employers were left to create a health care system of their own for their employees.
A truly useful virtual-first plan should be designed around the needs of members. It should be readily accessible, and must have the necessary framework and processes to reduce fragmentation between visits.
If proven effective, this sort of plan can also help reduce the cost of care. Instead of spending time and effort seeing different doctors to try and address one issue at a time, virtual-first plans intentionally designed around the needs of members can enable holistic, high-quality, affordable care that addresses all needs in one place.
Designing health care delivery solutions by leading with simplicity and efficiency
The most successful virtual-first plans offer a simple interface in which members can access whatever care they need, fast.
Great plans can be organized with an easy-to-understand model, making it easy for patients to select options during open enrollment. There is clear demand for this – employers are continuing to look for more comprehensive, sustainable health care options for their employees.
In addition to a well-designed plan, some offerings include health coaches that can provide wrap-around care for a holistic approach to a member's wellbeing. Health coaches are there to work with the member in response to their specific needs, alongside their health goals, and assist in a plan to achieve them. Coaches can also support navigating the different care options available, which can be overwhelming for members without proper guidance.
Questions that arise such as "where do I go to get a blood test?" or "are they going to take my insurance?" can all be answered promptly with the help of coaches. A coach can serve as a conduit of a health plan that assists members in receiving the care they need and following through with treatment recommendations.
Meeting employee preferences and reducing fragmentation
Employees want convenient, affordable care
Employers want to meet their employees' preferences while also reducing the administrative burden.
Providers want a less fragmented system and a better experience, while preserving the physician-patient relationship.
The future of virtual health care must make fragmentation a thing of the past. Patients cannot be left holding the bag, responsible for weaving the thread of their care from provider to provider. A virtual-first health plan can help. Virtual-first plans can bring together those threads of care all in one place, building strong and reliable relationships with care team members and increasing members' engagement with their own care as they work toward achieving their health goals.
Dr. Nina Birnbaum, medical director, Innovation Acceleration at Blue Shield of California
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