Regional insurers see growth potential in virtual-first plans
WHEN PRIORITY HEALTH launched its premier virtual-first plan at the end of 2020, Carrie Kincaid, vice president of individual markets, said she expected maybe 3,000 individuals to enroll. Instead, 5,000 people signed up.
“It feels like it's meeting a need that is evolving and hasn't been met before, and it feels like something that will meet a need that will likely continue to grow as future times continue,” Kincaid said.
Over the past few years, an increasing number of regional insurers have launched virtual-first plans for the first time, mimicking the moves of startups like Oscar Health and requiring individuals to consult with a primary-care doctor virtually before they come in for an in-person visit.
The plans claim they can save money by shifting care to lower-cost settings and increasing consumer access to care, thereby catching health issues sooner. Dr. Jean Abraham, Wegmiller Professor of Healthcare Administration at the University of Minnesota, said that these plans represent the first-generation of virtual-first coverage since the economics of the model have not been proven yet, adding, “It is too early to know how cost-effective these benefit designs will be and, honestly, I don't think we can know until we get out of the COVID environment.”
In addition to saving users time and up to 8% compared with other Priority Health plans, Kincaid said the Grand Rapids, Mich.based insurer's product helps individuals with chronic conditions man
From February to April 2020, Harvard Pilgrim Health Care’s Connecticut Market plan saw a 6,000% increase in the use of urgentcare telemedicine
age their care, and provides access to those living in remote regions of Michigan. The COVID-19 pandemic has also driven consumer interest in telemedicine, Kincaid said, although the MyPriority Telehealth PCP plan was in the making about a year and a half before the first coronavirus case was reported in the U.S. In April 2019, one in 1,000 of Priority Health's 1.2 million members' visits were conducted virtually; in April 2020, it was one in five.
“Sometimes you just find that perfect time,” Kincaid said. “We had the right option at the right time, and it all came together at once.”
From February to April 2020, Harvard Pilgrim Health Care's Connecticut Market plan saw a 6,000% increase in the use of urgent-care telemedicine among its 2.4 million members, according to Paul Bartosic, a vice president at the Wellesley, Mass.-based insurer. He expects 500 plans with more than 50 members to have signed up for the payer's SimplyVirtual coverage by the end of the year, which it launched in partnership with health tech provider Doctor on Demand. With its cost coming in at up to 10% cheaper than some of Harvard Pilgrim's plans, he said it attracts companies that are looking to save on insurance costs.
Abraham said she sees parallels between the movement to virtual-first plans and the health maintenance plans of yesteryear, with virtual-first plans acting as a gatekeeper for consumers and aiming to help consumers navigate the healthcare system in a cost-effective way.
Brad Ellis, senior director of insurance at Fitch Ratings, said that, right now, the majority of virtual-first plans are like Priority Health's, and offered by regional insurers to cover individuals, in a move to differentiate themselves from larger payers in their market. But he can see the benefit for larger insurers like Cigna and UnitedHealthcare that sell to larger employer-groups to eventually offer virtual-first plans since the coverage would allow employees to visit their doctor without taking a half-day off.
Going forward, it will be interesting to see how these models shift consumer consumption of in-person primary care to specialized, virtual providers, and how the data flows between tech companies and more traditional healthcare providers. He said all of this will have an impact on how providers structure their operations. He noted that virtual visits do not necessarily require an examination room, which could save providers cost on space and give them the capacity
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HHS IS STANDING UP an AI Council as part of its evolving approach to using and regulating the technology.
The strategy, developed over the last year and designed to align priorities across the department, is the latest sign of HHS ramping up its focus on artificial intelligence.
The Food and Drug Administration recently released a five-pronged action plan to underpin its approach to regulating medical software with AI or machine learning components. HHS in late January named Oki Mek, formerly a senior adviser to the HHS chief information officer, its first-ever chief AI officer.
Mek will co-chair the AI Council. He shared the HHS AI strategy, which was developed during the Trump administration, in a post on LinkedIn last week.
“As the department builds upon its current capabilities and adapts to a changing environment and emerging technology, HHS recognizes that Artificial Intelligence (AI) will be a critical enabler of its mission in the future,” the eight-page AI strategy report reads. “An enterprise AI strategy will provide direction and guidance in achieving the department’s AI ambition.”
The overarching vision behind the strategy, according to the report, is for HHS to work with academia, industry and other government agencies to leverage AI to “solve previously unsolvable problems” by spearheading advancements for Americans’ health and well-being and scaling adoption of “trustworthy AI” across the department.
The strategy is also meant to guide the council, which is charged with homing in on four areas: building the HHS workforce’s familiarity with AI; encouraging health AI research and development; making AI tools and resources more accessible; and promoting trustworthy and ethical AI development.
The AI Council will develop a report on its progress each year for HHS leadership.
The AI strategy builds on previous work from HHS agencies, including the FDA’s work toward developing regulatory frameworks for AI software and the National Institutes of Health funding research into AI-based projects, according to the report. It’s also aligned with two executive orders on AI signed by former President Donald Trump. ●
Aaron Chang
President, Sisters of Charity Hospital and Sisters of Charity Hospital, St. Joseph Campus Modern Healthcare's Emerging Leaders, Class of 2020
MH: Now that you've been in the field and you're a CEO, is there anything that you wish you would have learned in health administration school that you didn't?
Chang:
A lot of our work in the healthcare industry, and especially now in the CEO role, is making sure we set the right infrastructure, inspire folks and support our individuals. Communication is a big part of that. And I think I've naturally picked up those skills through work and through jobs. But there could be more in school about the basics: influencing, how to manage difficult conversations, how to inspire people, how to share your experiences that may be valuable for others to learn. That would have been terrific to know on the front end.
MH: In terms of your own career, did you get any important advice or guidance from someone that has proved key so far?
Chang:
Yes. I had a boss early, early on, who said to me, "You know, in this line of work, you have to be comfortable with being uncomfortable." He told me that on several occasions, and there was one time that was very pivotal for me, because it was a point in my career where I needed to step out of my normal routine. I needed to face some adversity and grow and gain those skills to advance professionally. Healthcare is changing so rapidly. Obviously we're in the thick of things with the pandemic and everything else. If you build that tolerance and you have that attitude where you can take on all and be nimble, adaptable, I think that's a valuable trait.
MH: Is there anybody that you have as a role model, excluding people you know personally?
Chang: This is a hard one because I have so many, but if I were to narrow it to two individuals who have inspired me, it'd probably be Wynton Marsalis and John Wooden. Growing up, I played the trumpet, and that's how I learned of Wynton Marsalis. I admired him as a jazz musician because boy, can he make the notes come alive. But what was more amazing was how he left his unique signature on everything he played. I looked up to him a lot, and I think he gave me the confidence to try to do that in and out of music. John Wooden, he was just a great philosopher who happened to be a successful basketball coach. I think he did wonders in terms of building a winning culture at UCLA. But he helped people succeed on and off that court, and I think that was very important to him. And I would say I share that same passion, so in terms of working with the folks on my team, I hope to have that kind of impact. ●
ONE OF THE NATION’S most prominent health policy researchers, Stephen Shortell has influenced the industry on a number of fronts—from understanding how financial incentives can be used to drive improvements in quality of care to assessing how policy decisions impact care delivery at a local level.
Shortell will be inducted into the Modern Healthcare Health Care Hall of Fame during a virtual ceremony on March 25. The celebration, which will also pay tribute to the late Bernard Tyson, the 2020 inductee, is held in conjunction with the American College of Healthcare Executives’ Congress on Healthcare Leadership.
“I am grateful for the opportunities that I have had to influence healthcare policy and practice,” Shortell said. “I am humbled by this honor. Our healthcare system provides benefits for many but not all. I hope that we can use the lessons learned from the COVID-19 pandemic to accelerate the changes needed to have a more responsive, accessible and consistently higher quality, more efficient healthcare system for all.”
Shortell is a professor of health policy and dean emeritus at the University of California at Berkeley School of Public Health. He serves as co-director of the Center for Healthcare Organizational & Innovation Research, co-director of the Center for Lean Engagement & Research in Healthcare, and has held the Blue Cross of California Distinguished Professorship of Health Policy and Management. He received his bachelor’s degree from the University of Notre Dame and a master’s degree in public health from UCLA. He earned a Ph.D. in behavioral science from the University of Chicago.●