The use of telemedicine skyrocketed during the pandemic, transforming health care with a convenient alternative to in-person visits. Telemedicine can afford patients increased access to care and preventive services as well as an integrated digital experience. This was certainly a welcome and long-overdue development, for both patients and clinicians.
But now, some health insurance companies are using telehealth technology for all the wrong reasons: to limit access to doctors, tests and in-person visits. These new offerings are called “virtual health plans” and they should worry us all.
Virtual health plans take various forms, but all encourage (and sometimes require) video visits before meeting a clinician or getting a test or service in-person. In some cases, this online gatekeeper is a doctor the patient has never met, and will never meet face to face. Insurance giants such as Aetna, UnitedHealthcare, Cigna, Humana, Kaiser Permanente and Oscar have all recently introduced versions of virtual health plans. Many virtual plans entice consumers with lower premiums and cost-sharing.
To be sure, telemedicine, as a clinical tool, can put the best attributes of our health care system front and center: increased efficiency, immediate care, and in the best of cases, concierge service. Telehealth can eliminate urgent care and even emergency room visits, offer greater access to specialists and help chronically ill patients manage their conditions with fewer trips to the doctor’s office. And virtual health plans that use a digital platform to unify a patient’s care could provide great value — 24/7 access, lab integration, pharmacy integration, lower costs and a focus on primary care.
But virtual health plans that use telehealth as a gatekeeper — before other care is available to a patient — are very different. This benefit structure actually takes the worst attributes of our health care system — disconnected care, limited patient choice and inequity — and makes them front-and-center.
To start, many insurers offering virtual health plans hire outside firms to provide online medical staff. In many cases, this is not a problem. But in some cases, those doctors are strangers to all the doctors who care for that patient in-person. Even worse, these third-party providers often have their own medical records systems, complicating data sharing. This divides a patient’s care into silos, exactly the kind of inefficiency that technology should be solving, not making worse.
Virtual health plans also present serious equity issues. Thirty-two million Americans lack the digital literacy to use a computer. One-third of these Americans are seniors, but digital illiteracy is also common among individuals of Black or Hispanic origin with lower incomes and educational attainment. Four in 10 adults with incomes below $30,000 do not have home broadband services or a desktop or laptop computer. Thirty-one percent of rural areas lack access to high-speed broadband. And while less well known, many lower-income urban areas lack such access as well. A health plan that requires the initial use of a video visit to access in-person care could largely deny in-person care to those with technical or other barriers to telehealth.
The online gatekeeper approach of virtual health plans feels awfully familiar to people who experienced healthcare in the 1990s. Back then, insurers forced patients and doctors into tightly controlled HMOs that sharply curtailed patient choice. The goal was to control rising medical costs, and 51 percent of job-based health insurance enrollment was in HMOs by 1998. Consumer backlash was significant, with many accusing plans of providing inadequate access to services, and calling for increased regulation. Even so, HMOs never lost substantial market share, particularly in areas of the country with high costs. Virtual health plans could have a similar trajectory.
As the leader of an independent, non-profit hospital deeply connected to our community, and one that was hit early and hard by the pandemic, I know that technology is a tremendous clinical tool for lowering barriers to care. I hope it becomes a regular site of care for many patients.
But don’t confuse virtual care with a virtual health insurance plan. Technology builds walls as easily as it tears them down.
Kathleen Silard is president and chief executive officer of Stamford Health in Stamford, Ct.