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Maximizing the value of virtual care for Medicare and Medicaid

Virtual care for the Medicare and Medicaid populations

5 min read


Maximizing the value of virtual care for Medicare and Medicaid


Dan Trencher

This post is sponsored by Teladoc Health.

As aging populations and chronic diseases increase demand for complex care, virtual care is increasingly seen as a solution to improve outcomes while bringing benefits for health plans. SmartBrief recently spoke with Dan Trencher, senior VP of product & corporate strategy at Teladoc Health, on how health plans can maximize the value of their virtual health efforts, particularly for the Medicare Advantage and Medicaid populations.

Why is virtual care growing in importance for the Medicare and Medicaid populations?

In the US, about 45% of people have at least one chronic disease, and this percentage is projected to grow. Meanwhile, about 33% of Americans delay medical treatment because of cost. For many Medicare and Medicaid members, accessing care is made even more challenging by low income, lack of transportation options and limited mobility.

Health plans that provide an accessible, affordable option via virtual care can lower costs and increase their members’ access to high-quality, comprehensive care. Virtual care can also help plans create an entry point for their members and route members to the right care, reduce the use of emergency departments, broaden physician networks and increase in-network referrals.

Experience with the Coronavirus 2019 (COVID-19) pandemic and recent regionally contained crises such as the Paradise, California “Camp Fire” have further confirmed the true value of virtual care, especially for the most vulnerable, high-risk populations.

Why is now the time for health plans to invest in a virtual care strategy?

Currently, federal and state policymakers and government agencies are actively revising regulations, requirements and recommendations, thereby opening telemedicine for patients and providers, with special attention to Medicare Advantage and Medicaid populations.  A proposal is pending to increase Medicare Advantage members’ telehealth access to specialty care and include virtual care in network adequacy standards for Dermatology, Psychiatry, Cardiology, Otolaryngology, and Neurology.

And increasingly, consumers expect personalized care on their terms and are reporting high levels of satisfaction with virtual care, according to the 2019 U.S. Telehealth Satisfaction Study by J.D. Power.

Health plans are responding to these changes. The 2019 AHIP Virtual Care Survey of Health Plans showed 92% of Medicare Advantage and 62% of Medicaid plans were offering virtual care. Today, we are seeing health plans waive out-of-pocket costs for virtual visits and recommending their use to reduce the spread of illness. For example, Dr. Terry Gilliland, EVP of Blue Shield of California, said in a recent statement that “as we continue to closely monitor the COVID-19 situation, we believe making telemedicine more readily available is the right thing to do.”

Comprehensive virtual care offerings can help payers differentiate their offerings, engage members and improve their experience by making care more convenient and providing help to manage complex, chronic conditions. This is especially important as Medicare Advantage competition and consolidation continues. And, it’s important for improving Star Ratings, which can significantly affect plan enrollment and retention. In 2018, the highest-rated plans – those with four or more stars – served 74% of Medicare Advantage enrollees. Virtual care can also help plans meet HEDIS Measures, including member experience metrics.

What does the virtual care future look like for health plans?

The Medicaid population is projected to increase to over 82 million beneficiaries by 2026 and the Medicare Advantage population is expected to increase to over 80 million by 2030. To best serve these populations, virtual care offerings should address a broad range of needs from day-to-day issues to integrated care for complex conditions and have the ability to support members in times of crisis. Members will need 24/7 access to physicians in a wide range of specialties.

Teladoc Health notes there are three waves of adoption for telehealth, and payers that reach the third wave will see the greatest benefits:

  • Telehealth as an alternative for convenient, cost-effective delivery of clinical and health services, including general medical, behavioral health and dermatology.
  • Integrated telehealth as part of the broader health continuum, with access to experts for complex case reviews and specialty care spanning a full range of needs regardless of location.
  • Telehealth as a locus of primary care delivery and care coordination, including access to primary care providers through telemedicine touchpoints for personalized treatment planning and care navigation.

Virtual care is not a separate and isolated way to access healthcare; it’s increasingly the ‘front door’ to the healthcare system and must be frictionless, secure, and integrated so that members are provided with the best experience and outcomes.

What should health plans look for in a virtual care partner?

To maximize the value of virtual care, health plans require an experienced a partner with leadership capabilities to deliver on ever-increasing expectations with the broadest spectrum of clinical services, the highest clinical quality standards, scalable platforms, a track record of meeting challenges with sustainable and consistent innovation, and proven expertise collaboratively engaging members within diverse populations to drive utilization.

Health plans should expect to partner with a single virtual care provider to connect their members with a full spectrum of care through a unified experience – one that is fully integrated into the healthcare ecosystem. By offering virtual services that improve the member experience with greater convenience, outcomes and value, payers can ensure they are providing the most cost-effective and high-quality care.

Teladoc Health is the global leader in virtual care, offering integrated, comprehensive virtual care solutions to meet the growing needs of the Medicare and Medicaid populations. In 2019, we delivered over 4 million virtual care visits globally. Learn more.