Virtual-First Care

Insurers are investing in virtual-first health plans as a way to provide more options, convenience for consumers.

January 2022 – The Journal of Healthcare Contracting

By Pete Mercer

All it took was a pandemic. Among many other things, the coronavirus pandemic revealed the fragility of our healthcare infrastructure in the face of a massive disruption. Accessibility weaknesses laid bare, primary care and physician offices had to think of a creative way to ensure that their patients received the care that they required, while maintaining COVID safety protocols. In an effort to keep people as safe as possible, many primary care offices moved services to virtual appointments that allowed patients to be seen at the height of the COVID-19 surges.

Virtual health care is a precious commodity in a time when access to health care is more strained than ever. McKinsey conducted a study in July that found that “telehealth utilization has stabilized at levels 38 times higher than before the pandemic.” Not only is telemedicine a valuable resource for those who need it, but it’s becoming more popular as people see the benefits of leveraging virtual care for their needs.

Cigna recently announced that it is significantly expanding access to covered virtual care services for millions of customers. After the recent acquisition of MDLIVE by Evernorth, Cigna’s health services business, Cigna is pushing to be an innovative provider of virtual care services at a time when people are most interested. In a media release, Dr. Cynthia Zelis, chief medical officer at MDLIVE, said, “Together, we are creating a best-in-class, coordinated virtual care experience for millions of patients – improving each person’s unique health journey with support from a wide network of providers.”

Despite its inherent limitations, virtual health care provides patients and providers with a unique opportunity to maintain a consistent level of care in a time rampant with inconsistency. In the height of the pandemic, telehealth was a critical tool for primary care practitioners who had to close their offices. Even if the standard of care isn’t quite the same as when patients are in the office, virtual care affords the patients an opportunity to be seen from the comfort of their own home and the convenience of their own schedule.

Heather Dlogolenski, senior vice president, Solutions, Cigna, said in a media release, “At Cigna, we are constantly innovating our plan designs to meet the needs of our customers while continuing to make health care more affordable, predictable and simple. Expanding into virtual-first health plans is the next step in providing a convenient and comprehensive care experience.”

How it works

Beginning in January 2022, all Cigna customers who are enrolled in employer-sponsored plans will have access to MDLIVE’s network of virtual primary care providers for routine care visits, sick visits, prescription refills, or to follow up on a condition that wasn’t addressed during a wellness visit. In addition to the virtual care visits that Cigna customers can schedule at their convenience, it will also seamlessly transition to an in-person visit as needed.

MDLIVE will refer to Cigna’s network of high-performing providers when face-to-face care is needed, with in-network specialists, lab work, and biometrics at in-network facilities. MDLIVE will also utilize the data provided by Cigna to proactively work with patients to close gaps in care, offer better care coordination and overall meet clinical medical needs. This coordination between MDLIVE providers or brick-and-mortar providers will be a critical component to ensure customers have a connected health care experience.

Dr. William Lopez, the national director of Virtual Care at Everworth, explained that MDLIVE is designed to make the patient experience seamless between virtual and in-person visits. “The partnership we have with brick-and-mortar providers in Cigna’s network remains an important tenet of our virtual care strategy, and our core commitment to them remains the same – to ensure they can continue to deliver care how, when, and where they want to,” he said. “That’s why we also offer our network of brick-and-mortar providers – including primary care physicians – the ability to leverage virtual care as part of their care offering through our Virtual Care Reimbursement Policy.”

Addressing the challenges in healthcare

One of the most significant and consistent challenges in healthcare is accessibility. Whether it’s geographic challenges in rural areas or transportation barriers for low-income people, accessibility is one of the hot button issues facing healthcare. Virtual care provides a unique opportunity for greater access across the spectrum, creating convenience for a wider range of people.

“The substantial expansion in MDLIVE services provides even more choices to our customers, continuing our trend of removing access-to-care limitations that some consumers face,” Lopez said. “Customers who have relationships with in-person providers will not be required to switch to a virtual provider. For many, virtual care offers another convenient way to receive care, and allows them to access care when are where they need it.”

Virtual care presents its own set of challenges for patients and primary care physicians. Despite the convenience and ease of access that a telemedicine call affords the patient, it’s impossible to address all of the patient’s needs using a remote service. While it still allows the patient to be seen by a medical professional, some appointments are simply better for in-person visits. MDLIVE is addressing the challenges of virtual care by ensuring that their customers are offered the best choices for what they need.

Additionally, Cigna customers will be able to use the MDLIVE services to address their mental health needs. “Since 2020, Cigna customers have had access to MDLIVE’s behavioral health care team in addition to the many other virtual providers within Cigna’s vast behavioral health care network,” Lopez said.

Virtual care in a post-pandemic world

While virtual care has become an invaluable resource to patients during the pandemic, what will happen once we move past
COVID-19? In a post-pandemic world, will there still be a need for virtual care?

Lopez believes that virtual care options “will remain a preference of customers, clients, and providers in a post-pandemic environment.” In fact, that’s part of why Cigna has implemented the virtual-first benefit plan pilot, as well as the permanent coverage of certain virtual services for their network of brick-and-mortar providers.

“The massive acceptance and adoption of virtual care during the pandemic has reshaped the delivery of medical and behavioral health care,” he said. “In addition, consumers have come to expect the same level of convenience in health care as they see in other industries such as finance and retail. Our customers and clients value convenient access to high quality care and are increasingly finding virtual care is a great way to meet their health needs. We also know that virtual provides an access point to health care, allowing customers to have more flexibility when it comes to care. In fact, more than 75 percent of Cigna customers who had an MDLIVE virtual wellness screening in 2020 did not have a PCP – and two-thirds identified a health condition as a result of the virtual screening.”

In the post-pandemic world, there will still be a need for easy access to healthcare for rural communities and low-income families, as well as a variety of choices for customers who have come to expect a virtual health solution to their needs.

“Our customers value convenient access to high-quality care and are increasingly finding virtual care is a great way to meet their health needs. This substantial expansion in MDLIVE services provides even more of those choices to our customers,” Dlogolenski said. “Not only will this give more people an additional entry point to the health care system, but patients will be able to build lasting relationships with their preferred MDLIVE provider just as they would in a traditional office setting.”