Virtual Care Partners for commercial large groups launching July 1

05/09/2022

Prior to the COVID-19 pandemic, virtual healthcare was rarely utilized, but today the use of telehealth services and virtual-first health care has increased rapidly. Due to the market demand and changing landscape in health care, we’re launching Virtual Care Partners for large groups, effective July 1, 2022.

This product is designed to navigate members through a new, lower-cost, virtual care delivery model while providing a high level of care and personalized support. Each member’s virtual care team includes a PCP, RN and medical assistants. This team creates a personalized care plan, provides treatment, coordinates referrals to in-network, high-value providers, schedules appointments and follow-ups, and addresses gaps in care.

Members who'll benefit from this plan

Employers can choose to offer this plan to their workforce, and their employees choose whether to participate in the plan to see providers through a virtual front door. When members need to receive care in person, they’ll be directed to in-network providers and facilities. Employers may offer Virtual Care Partners alongside other traditional plans, so members can choose the plan that best fits their needs.

This plan is designed for members who are:

• Dispersed, transient, or disengaged and may not have a strong relationship with their provider or know how to navigate the health care system
• Digitally connected and competent
• Lacking convenient care (e.g. located in a rural area where convenient access to services is limited or in urban areas where accessing care is a hassle).
• Have low engagement with their in-person PCP.

The member experience

Members who’ve selected this plan through their employer will access care virtually first (unless emergent), via the Virtual Care Partners network, where their care team helps to triage their needs to the appropriate virtual provider or refers them to one of our high-quality, in-network providers (HMO/POS/PPO). Members will have a $0 cost-share for all virtual services and will see a higher cost-share when they seek care through an in-person facility.

Provider Impact

There will be a low disruption for members with longstanding, strong PCP relationships and who don’t want to see their provider virtually or change PCPs.

If a member chooses to select a virtual PCP through Virtual Care Partners, the member will be assigned to the virtual PCP, including for incentive programs.

Members who need in-person care for imaging or specialty care, will be referred in-network. Referrals from the virtual PCP will look like any other referral, with the virtual PCP coordinating record transfers, etc. Virtual Care Partners will initiate the referral to the specialist or facility, and coordinate with the specialist for the visit summary and any other clinical information needed by the virtual PCP.