How UnitedHealth, Aetna and Centene are tackling virtual-first care

How UnitedHealth, Aetna and Centene are tackling virtual-first care


Health insurers are betting big on individuals continuing to use virtual care post-pandemic, with UnitedHealth Group, Centene Corp. and CVS Health’s Aetna all recently announcing new virtual-first offerings.

Seventy-two percent of employees said they plan to “keep using” telehealth once the public health crisis has ended, according to a report last month from employee benefits consultancy Mercer. Among individual customers, telehealth use fell to just 4.2% of all visits in July, although virtual visits remained popular in certain specialties like psychotherapy, with 60.8% of sessions conducted remotely, according to FAIR Health’s Monthly Telehealth Regional Tracker. In response to employer and consumer demand, insurers are continuing to launch virtual-first plans, although their strategy for getting the products to market varies by insurer. These recent announcements by national, for-profit insurers follow the launch of virtual-first plans by regional payers at the start of 2020.

“There’s a lot of push and pull right now,” said Deana Bell, a principal and consulting actuary at Milliman. “Figuring out where telehealth’s going to stabilize and having health plans with more experience contracting with vendors, and vice versa.”

By increasing access and shifting the cost of care to lower-cost settings, health plans think they can save costs. And across all these plans, consumers don’t need to pay a copay to visit their virtual doctors, saving enrollees on healthcare costs too. But because these plans are so new, the data on how much they save on healthcare costs for insurers is mixed, with some saying virtual-first plans can act as an unnecessary gatekeeper for care and eventually just delay an individual’s eventual visit to an in-person provider. Questions about what long-term reimbursement for these services should look like also linger, Bell said.

“You can’t do everything via telehealth,” Bell said. “It’s a great place to start, as far as answering questions on whether to go in and do something more intensive. Don’t Google your own stuff, start with a telehealth provider. I think that’s the promise. But it’ll be interesting to see now whether employers and consumers will go for this, or are they tired of it after having to deal with it throughout the pandemic.”

UnitedHealth Group’s insurance subsidiary unveiled its inaugural virtual-first plan on Tuesday, which will be available to employers in nine markets come 2022 and combines its Optum physician arm with its UnitedHealthcare insurance network. Named NavigateNOW, the company’s 60,000 Optum physicians will oversee individuals’ virtual primary, urgent and behavioral health services, with UnitedHealthcare’s physician network available as a backup for any in-person needs, which includes more than 1,600 facilities in Optum’s national ambulatory provider network.

Members enrolled in the plan will receive a personalized care team and will have access to a wearable device for a wellbeing program that offers financial perks for achieving specific health targets.

By identifying patients’ health issues earlier and steering them toward the lowest cost site of care, UnitedHealth Group said it plans to cut premiums by 15% compared with its more traditional offerings. By the end of 2022, the company plans to unveil it across 25 markets and “is watching this in the self-funded space,” said Dr. Donna O’Shea, chief medical officer of population health. She declined to comment on the number of members UnitedHealthcare expects to enroll in its virtual-first plan.

“If this works, then this model could be moved more nationally, right?” O’Shea said. “We think of it more as an integrated health system, just like there are across the country. But it just happens that we happen to be a national, and not a regional system, and so we have different opportunities and different responsibilities to meet the needs of our members.”

By building an in-house system, UnitedHealth Group can keep patient health information in a single place, making it easy for providers across the country to access and ensure that members are referred to the appropriate specialist, O’Shea said. Cigna is also pursuing a similar, in-house strategy through its acquisition of MDLive earlier this year, with some saying the company plans to market its virtual capabilities to other smaller health plans.

Other insurers, meanwhile, are looking outside their company walls for virtual vendors.

Centene’s Amwell business announced on Tuesday was partnering with Teladoc Health to launch a virtual-first plan for exchange customers in four states come 2022. Last week, CVS’ Aetna also announced it was partnering with Teladoc to launch its virtual primary care services nationwide. Both will rely on the company’s Primary360 tool to scale their digital offerings, said Robert Bressler, senior vice president of Primary360 at Teladoc.

Bressler declined to comment on the number of providers Teladoc employs and the number of payer lives Teladoc is responsible for. But he said plan sponsors typically see savings of 10% when they partner with the company to create a virtual plan.

At the end of the company’s most recent second quarter, Teladoc reported 3.5 million visits, up 28% from 2.7 million during the same time last year. The company also logged more than 1 million “platform-enabled sessions,” where health systems use its product to connect to patients, during the quarter. The feature was not available the year before.

“Virtual primary care as a category is really the future and the mega trend,” Bressler said. “That’s shifting in the virtual care industry as we move away from just transactions and the more urgent care model to truly longitudinal relationships with providers.”



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