Part 2: 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 many beneficial factors aside from convenience and flexibility.  

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

  • Better Chronic Care/Disease Management: Plan sponsors are bracing for an increase in medical costs for chronic disease utilization. A virtual care vendor that has no limits on virtual primary care usage allows patients to have more frequent and longer visits with a doctor to get health on track. 30% of ER visits for those with chronic conditions are potentially unnecessary and offering convenient, quick access to a patient’s primary care physician in a virtual setting will deter them from electing expensive healthcare modalities. Vendors should have next-day appointments available, offer unlimited visits and guarantee at least 25 minutes with a doctor. 75% of primary care visits are for those with multiple chronic conditions, however 85% of PCPs reveal they do not have adequate time to support patients with a chronic disease. Virtual primary care is a valuable resource for disease management as members spend more time with doctors to create unique treatment plans to best fit their needs.  
  • Getting Health Back on Track & Mitigating Claims Risks: Delayed or skipped care due to the pandemic and other personal barriers increases the risk of high-cost claims to the plan. In fact, between 2021-2023, stop-loss premiums increased by 16%. Engaging employees in their health with annual wellness exams, preventive care and hands-on disease management (as mentioned above) can reduce the risk of such claims. 

Bonus Market Trends to Look Out for According to HRI:  

  • The Cost of Care Management: Chronic diseases account 84% of medical plan costs and cost employers $36.4 billion in missed workdays per year. A virtual primary care solution can help employees get their chronic conditions under control for more healthcare savings. Frequent, longer visits in a convenient virtual setting allow for better collaboration and understanding of a patient’s social determinants of health that affect comorbidities. Should in-person care be needed, virtual care vendors must refer to in-network, high-quality specialists while also considering appointment availability, proximity and other patient preferences.  
  • Behavioral Health: Visits for mental health are 4.8-5.1x more likely to be out of network compared to primary care visits. Primary care physicians are also the primary managers for those with a mental illness – up to 75% of primary care visits have a mental health component. A study found that those with telemedicine exposure were 2x more likely to receive a mental health screening. All of this is to say that virtual primary care can diagnose, treat and support patients with mental health concerns comparably or even better than in-person care.  

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 5:19:02 PM.