Pandemic boosts transition to virtual primary care

Woman video calls another woman on a tablet.

Virtual primary care could soon become more common as employers and employees adjust to the new normal of telemedicine as the preferred place of treatment.

Once mainly perceived as a way for people to occasionally get urgent care, telemedicine is now viewed as a cost effective, convenient way to build a relationship with a primary care physician (PCP) who can care for a broader range of healthcare needs. Employees have come to appreciate the convenience it offers, and employers welcome more options for offering health coverage.

In January and February of 2020, Humana members were scheduling a few hundred telemedicine visits per day. By April 2020 that number increased to over 1 million. The COVID-19 pandemic has accelerated the shift, as telemedicine offers patients safe alternatives for accessing healthcare. The virus eliminated most consumers’ reluctance to use virtual care because of their uncertainty with seeing a physician through a screen.

The number of U.S. patients who have had at least one telehealth visit has increased 57% since the pandemic started, according to a telemedicine study by Doximity, a professional medical network. The adoption has been so significant that telemedicine is forecast to account for 20% of all medical visits and $29.3 billion of services in 2020.1

Virtual primary care could be the next step in the healthcare industry’s transformation because it moves healthcare beyond telemedicine, opens new window, blending convenience with holistic care.

Primary care challenges

Though studies show that patients benefit from continuity of care,2 researchers also have found that the percentage of U.S. adults with a PCP has declined to 75%.3 While the change from 77% in 2002 to 75% in 2015 seems small, it means nearly 9 million people did not have a PCP during a span of 13 years. The percentage could decrease further due to a projected shortage of PCPs4 that could reach 55,200 providers by 2030 and a preference for alternative-care providers, such as retail clinics, among younger adults.5

Telemedicine may be able to stem the decline in utilization of primary care by increasing access and improving the patient experience. This could lead to better care outcomes and savings. According to Primary Care Progress, adults with a primary care provider have 19% lower odds of premature death than those who only see specialists, and people who have a primary care provider save 33% on healthcare over their peers who only see specialists.6

Humana’s On Hand service offers an example. On Hand is a first-of-its-kind virtual primary care health plan that Humana started through a partnership with Doctor On Demand in fall 2019. Humana offers On Hand through employer benefit plans as a lower cost option with greater scheduling flexibility than traditional doctor office visits. The insurer cites improved outcomes as well.

Doctor On Demand touts:

  • 5 times faster for initial primary care visit, scheduling laboratory work and getting results than an in-person doctor
  • 92% case resolution rate in just one visit
  • 14-day revisit rate that is 3 times lower than competitors

On Hand offers:

  • Unlimited $0 virtual primary care visits
  • Unlimited $0 urgent care visits
  • Preventive care services, including in-person care, at no additional cost to members

Virtual care is provided through Doctor On Demand’s full-time, board-certified PCPs. Doctors are always available, and patients can join their appointments from anywhere in the U.S. with remote access.

A virtual-first primary care plan

On Hand encourages employees to build long-term relationships with PCPs. Patients can see the same provider for complex issues and needs, laboratory services, prescriptions and X-rays. Employees receive primary care kits with blood pressure cuffs and thermometers as well, so that they help improve their care by providing data to their physician.

Though in-person care is still available through Humana’s network of providers, On Hand puts virtual care first because telemedicine can deliver the right care at the right time with lower costs.

Employers benefit from telemedicine because it encourages employees to engage in preventive care, fits a geographically diverse workforce, lowers absenteeism with fewer in-office visits and time away from work, and reduces urgent care and emergency room (ER) visits and their associated costs.

Telemedicine also helps employees by increasing convenience and safety through at-home, at-work, or on-the-road care options with minimal wait times; creating care continuity and integrating primary care, behavioral health and chronic care; providing on-demand care for non-emergency needs when brick-and-mortar offices are closed; and increasing access to diverse visit types, including PCPs, specialists, second opinions and provider-to-provider communication. On Hand also offers a full-service care team that can locate and schedule appointments for employees if they need in-person care.

On Hand members get coordinated and continuous care through Doctor On Demand, which provides a single primary care touchpoint for all their care. This touchpoint also provides members with full views of their care experience because it receives any results from referred care.

Doctor On Demand is the primary care provider for adults and anyone over 2 years old with unlimited $0 virtual visits for primary care and urgent care. A virtual visit can cover anything a person would do at a traditional brick-and-mortar PCP. If a member has a child who is 2 years old or younger, they would see their pediatrician, and the cost would be the negotiated amount of their plan. All preventive and well-baby care would be covered at no additional cost.

On Hand has 2 key cost-saving differences for employees: $0 virtual primary and urgent care, and $5 for most common prescriptions and laboratory services. Also, they get a concierge team that coordinates care through Doctor On Demand, unlike members in a traditional HDHP.

On Hand members also can access care through a mobile application and cover out-of-pocket expenses through spending accounts.

Adoption by employers

The demographics of On Hand members are similar to those of Humana’s non-virtual plans. Humana expects more employers to offer On Hand in 2021 now that their covered employees have become comfortable with telemedicine and they have seen how their companies can benefit.

“Humana has always been on the forefront of innovative plan design, and we were thrilled to partner with them in 2019 to roll out the nation’s first virtual primary care health plan, On Hand,” said Doctor on Demand CEO Hill Ferguson. “In doing so, we not only improved access to quality primary care and behavioral healthcare from the comfort and safety of members’ homes—a high-value benefit made even more critical as COVID hit—but did so at lower premium costs. We look forward to creating more market-first offerings together in the future.”

The COVID-19 pandemic may have jump-started the adoption of virtual primary care. But it has also permanently altered perceptions of what virtual primary care can become.

Sources:

  1. “2020 State of Telemedicine Report,” Doximity, last accessed January 13, 2021, https://c8y.doxcdn.com/image/upload/Press%20Blog/Research%20Reports/2020-state-telemedicine-report.pdf, PDF opens new window.
  2. DJ Pereira Gray, Kate Sidaway-Lee K, Eleanor White, et al. “Continuity of Care with Doctors—A Matter of Life and Death? A Systematic Review of Continuity of Care and Mortality,” BMJ Open 2018, (June 2018);8:e021161, last accessed January 13, 2021, doi:10.1136/ bmjopen-2017-021161.
  3. Linda Carroll, “Declining numbers of Americans have a primary care provider,” Reuters Health, December 16, 2019, last accessed January 13, 2021, https://www.reuters.com/article/us-health-pcp-trends/declining-numbers-of-americans-have-a-primary-care-provider-idUSKBN1YK1Z4, opens new window.
  4. “New Findings Confirm Predictions on Physician Shortage,” Association of American Medical Colleges, April 23, 2019, last accessed January 13, 2021, https://www.aamc.org/news-insights/press-releases/new-findings-confirm-predictions-physician-shortage, opens new window.
  5. Sandra Boodman, “Spurred by Convenience, Millennials Often Spurn the ‘Family Doctor’ Model,” Kaiser Family Foundation, October 9, 2018, last accessed January 13, 2021, https://khn.org/news/spurred-by-convenience-millennials-often-spurn-the-family-doctor-model/, opens new window.
  6. “The Case for Primary Care,” Primary Care Progress, last accessed January 13, 2021, https://www.primarycareprogress.org/primary-care-case/, opens new window.