Initially, the service will be part of some employer-sponsored insurance plans in 11 states. United intends to expand its footprint next year.
United is using the platform and the medical group of American Well, a telehealth service, to provide virtual primary care. Besides minor acute care, United’s virtual service covers annual wellness visits, routine follow-ups for chronic conditions, lab tests, and specialist referrals with little or no cost sharing.
The giant insurer is now offering its virtual primary care plan in Arizona, Colorado, Illinois, Maryland, North Carolina, Ohio, South Carolina, Texas, Virginia, Washington, D.C., and West Virginia.
Other insurers are offering similar virtual primary care plans. For example, Humana has partnered with Doctor on Demand, and Cigna is working with MDLive to offer virtual primary care plans. Both of these plans encourage consumers to form ongoing relationships with physicians hired by the telehealth services. Similarly, Harvard Pilgrim, which has also joined with Doctor on Demand, said that consumers get “virtual PCPs” along with a full care team.
Humana has priced the premiums for its virtual service at about half the cost of Humana’s most popular traditional plan. There are no copays for telehealth visits; there are $5 copays for common lab tests and prescriptions. Cigna said that its virtual plan makes coverage “more affordable,” but doesn’t provide any specifics.
According to United spokeswoman Maria Shydlo, the insurer’s virtual primary care service is not cheaper than its traditional products.
Increased telehealth adoption
When the COVID-19 pandemic first struck last year, telehealth was a lifesaver for primary care practices. Physicians were able to treat half or more of their patients through telehealth, including video and phone consultations.
That initial romance with telehealth did not last. Today, telehealth represents 9% of adult primary care visits. However, that’s still a much higher percentage than before 2020, and telehealth has become a fixture of primary care.
Prior to the pandemic, telehealth services dominated the virtual care space. Some large groups experimented with having their doctors conduct virtual consults with their patients. Other physicians dabbled with telehealth or stayed out of it entirely because health plans paid much less for virtual visits than for in-person visits.
That began to change as more and more states passed laws requiring payment parity. (Today, 36 states do.) Then as the pandemic took hold, Medicare loosened its regulations, allowing coverage of telehealth everywhere and establishing parity. But it’s unclear what will happen after the public health emergency ends.
United and other insurers portray their virtual primary care plans as an effort to connect more consumers with primary care physicians. Having a relationship with a primary care doctor, United noted in a press release, increases access to care, including preventive services. Moreover, a United survey found that a quarter of respondents preferred a virtual relationship with a primary care doctor.
Physician have mostly positive but mixed reactions
This news organization interviewed several physicians who practice in states where United has introduced its new offering. Only one doctor had heard about it, and another, solo family physician Will Sawyer, MD, of Cincinnati no longer contracts with United. Nevertheless, they all had strong opinions about virtual primary care plans from United and other insurers.
Dr. Sawyer is a big proponent of telehealth and notes that it’s “incredibly convenient” for older people, many of whom are afraid to come to the office out of fear they might contract COVID-19. He has found that telehealth can be useful for many kinds of acute and chronic care. But he believes (although he admits he does not have evidence) that United started its virtual primary care service mainly to save money.
Dr. Peter Basch
Peter Basch, MD, an internist with MedStar Health in Washington, D.C., says he’s willing to give United the benefit of the doubt. Increasing access to care while lowering its cost, he says, is the right thing to do, and “it makes financial sense. So I wouldn’t question their motives.”
Dr. Basch is concerned, however, that insurers such as United might eventually cover some services virtually but not in the office. “I can imagine a situation where doctors feel their judgment is being disregarded and that this person really needs to come in. And there might be pressure from the employer or the manager of the medical group, telling the doctor that if you’re not careful about how you manage these visits, you may be losing money for the practice.”
Kenneth Kubitschek, MD, an internist in a medium-sized group in Asheville, N.C., was less enamored of telehealth than Dr. Basch and Dr. Sawyer are, although it currently accounts for 15%-20% of his group’s visits. “There’s definitely something you lose with telehealth in terms of the nuances of the interaction.”
No to some kinds of telehealth doctors
The physicians we spoke with were unified in their opposition to virtual primary care plans that mainly use physicians hired by telehealth services. Dr. Sawyer noted that one-off consultations with telehealth doctors might be okay for urgent care. “But what we’re trying to do with patients is change their behavior for better health outcomes, and that doesn’t happen in these one-off contacts,” he said.
Even if a patient were able to develop an online relationship with a telehealth doctor, Dr. Basch said, there are any number of situations in which an in-person visit might be necessary. “Whether it’s a urologic visit, a cardiac visit, or an allergy visit, do I need to listen to you or put my hands on you to palpate your liver? Or is this just a conversation with someone I know to see how they’re doing, how they’re managing their meds? Ninety percent of a diagnosis is history.”
Although the virtual plans allow a telehealth physician to refer a patient to an in-network specialist for an office visit, this isn’t the same as their primary care physician asking them to come in to be examined.
Moreover, Dr. Basch noted, people with chronic conditions can’t be treated only virtually. “I wouldn’t say that primary care should be done predominantly through virtual visits. It may be okay for young and healthy patients, but not for older people with chronic conditions. There are times when they should see their doctor in person.”