Part 1: How a Virtual Care Program Can Support Cost Containment Strategies in 2024

October 24, 2023

First Stop Health

PwC’s Health Research Institute (HRI) recently released its Medical Cost Trend Report with some daunting projections for healthcare costs in 2024. HRI projects a 7.0% year-on-year medical cost trend in 2024 for individual and group markets citing inflationary impacts, high-cost specialty drugs and higher patient demand on an already strained health system as main factors for rising costs. 

The good news: HRI projects virtual care – specifically for primary care and mental health – will continue to be a dependable source for value-based care. As virtual care has become the “norm” for many, there are several beneficial factors aside from convenience and flexibility.  

How Virtual Care Can Decrease Healthcare Costs & What to Look for from a Vendor 

  • No Claims to the Group Health Plan: With a standalone virtual care provider, visits should not incur claims so as utilization of virtual care increases, claims impacts decrease. Plus, employers can avoid many of the carrier-embedded virtual care woes that impact plan costs (e.g., fragmented care coordination due to carriers being contractually obligated not to steer, fee-for-service models that harm patient experience, lack of targeted engagement, etc.).  
  • Diverting from More Expensive Healthcare Modalities: Opting for virtual care for urgent concerns, primary care or mental health needs keeps patients from using more expensive healthcare modalities such as emergency rooms or urgent care centers. Virtual care vendors should report at least 85% of virtual visits as cost diverting. 
  • Valued-Based Preventive Care Tactics: Engaging patients in their health early on and ensuring they are up to date on age- and gender-based screenings can prevent or slow chronic condition progression. Unfortunately, according to the CDC, most providers are paid to treat rather than prevent chronic diseases. A standalone virtual care vendor that is independent of hospital systems or carrier influence ensures the correct preventive care tactics are utilized to support healthier populations, and in turn, decrease healthcare costs.  

Bonus Market Trend to Look Out for According to HRI:  

  • Health Equity: Inherently virtual care enables equity of access, reducing transportation and geographic barriers, but improving access also must include multi-modality use (phone, app, and web), language availability (including ASL), time equity (off-hour and weekend availability for shift workers), dependent equity (all household members have access for free - as the patient defines household member), and cost ($0 cost for services). 

First Stop Health Virtual Care for Cost Containment Strategies 

With FSH Virtual Primary Care, Virtual Urgent Care (Telemedicine), and Virtual Mental Health, employers experience fewer medical claims and more diverted costs as employees are encouraged to use these little-to-no cost services. FSH virtual care runs outside of the insurance plan and does not incur medical claims for visits. By avoiding unnecessary in-person visits, significant savings occur with diverted costs. And with easy-to-access Virtual Primary Care, early prevention tactics and better care management for those with chronic diseases can also reduce healthcare costs. Navigating the healthcare system has never been easier and with FSH hands-on care coordination (included with Virtual Primary Care) referrals to in-network, high-quality providers are 26% less costly. Plus, with FSH Performance Guarantees, we put our fees at risk to ensure employers and employees get the most value from our virtual care.  

Originally published Oct 24, 2023 5:04:30 PM.