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Virtual-First Health Care Plans Hit the Market


In the continuing quest to reduce health care cost and make care more accessible, a new type of health plan has been taking shape: The Virtual-First Health Plan.

These evolving plans integrate virtual care delivery models into a comprehensive health plan that encourages enrollees to access virtual care with their doctors before resorting to an in-person visit. These plans are coming to market as Americans have gotten use to virtual visits with their doctors during the last three years of the COVID-19 pandemic and virtual care becomes more common even in traditional health plans.

While the uptake is small – 6% of employers surveyed in 2022 offered these plans – it’s expected to grow quickly over the next few years. Most of the major health insurers have already announced various tie-ups with virtual care providers and tech vendors to improve their telemedicine offerings.

There are a number of benefits to virtual-first primary care such as reduced cost, convenience and easier access with better health outcomes. Virtual-first plans may often put a premium on health record integration across the care spectrum to ensure that all care team members have access to them.

A recent survey by Mercer found that, among organizations with 500 or more employees:

· 52% planned to offer virtual behavioral health care in 2023.

· 40% planned to offer a virtual primary care physician network or service in 2023.

· 21% already offer virtual specialty care, like for dermatology or diabetes.


Virtual-first health plans include the same coverage as traditional health plans, including fee-for-service, HMO, and PPO, but they focus on directing enrollees to telemedicine options for their doctor’s visits.

The key difference is that they aim to significantly reduce cost by incentivizing enrollees to seek out virtual care first through plan design, incentives and advocacy. Sessions can often be performed virtually, saving both the patient and doctor time, while reducing the cost for each visit.

Virtual-first plans incorporate the same arrangements as traditional health plans, except that most doctor’s visits will be online, or via a smartphone app. When a patient needs to see their doctor, they’ll schedule the visit on their account and they need to opt out of a virtual visit if they feel they need to see the doctor in person. Additionally, if possible, specialist visits can also be conducted on the app or website.


Virtual-first care plans are an evolving product and it’s important to find a plan that can truly save you money while not sacrificing quality of care.

These plans are still in their infancy and are hitting the market in increasing numbers. But because they are new, there is no uniform standard for them. The most important aspects to look for in these plans are strong member engagement and seamless integration to ensure quality of care.

Give us a call today at 770.537.5300 if you have questions about these plans and if carriers in your area are offering them, and whether they are a good fit for you and your organization.

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