How to Assess Virtual Primary Care Solutions for Your Organization

Selecting a virtual care solution to integrate into your employee benefits package can be a challenge. With so many offerings available - and many vendors who offer similar products, it can be difficult to know if you are choosing the right one. Here are some questions and answers to consider when you are researching virtual care options for your organization:  

Part 1: Access For Your Employees 

Q: Is the solution able to provide care to your entire workforce continuously, regardless of where your employees live, work, and travel within the U.S.? 
A solution that can provide care to your entire  U.S. workforce at once will simplify things for your company and reduce challenges for you in the future. You will be able to provide benefit parity for all employees and ensure everyone has the same experience.  

Access doesn’t only mean a slick tech platform— access is also tied to how and when your employees can get care. Consider whether the solution offers flexible ways to get care such as asynchronous messaging and/or video visits, and what the provider availability looks like during and after work hours for your employees. Also, consider who is actually providing the care—some solutions rely on AI and bots to respond to care requests and questions which can result in a poor experience, especially in areas like mental health. 

Keep in mind that choosing a singular solution also means you eliminate the need for piecemeal solutions across different geographies. With one solution, you avoid multiple contracts, different fee schedules,  varied performance tracking and reporting, and the added challenge of having to piece together the complete picture of your employees’ overall health and company ROI.

Part 2: Care Model Evaluation

Q: Does the solution include comprehensive services like physical therapy and mental health - two of the biggest healthcare cost areas? 
The biggest healthcare cost drivers today are chronic conditions, musculoskeletal, and mental health and these issues often coexist and exacerbate each other. The most effective way to manage the overall health of your employees is to adopt an integrated model of care that includes physical therapy, mental health, in addition to primary care.

The health of your employees is not compartmentalized, so your healthcare shouldn’t be either. An integrated model provides an interdisciplinary team of clinicians who provide holistic care and see your employees as more than just the sum of their conditions. Because they can communicate and collaborate with each other seamlessly about their patients’ it allows for a more comprehensive and inclusive approach to care. This is a more effective way to address complex issues such as chronic, musculoskeletal, and mental health conditions, as treatment of these complex conditions often requires a comprehensive approach that crosses multiple disciplines. This ultimately leads to less confusion for the patients, reductions in unnecessary procedures and prescriptions, and cost.

The effectiveness of care for these high-cost areas should be measurable. Is your solution’s approach delivering results that are evidence-based,  quantifiable, and reproducible? 

Q: When in-person care is needed, how does the virtual primary care provider handle it?
There will be instances when in-person care is needed. Labs, imaging, certain assessments, and specialty care may require a patient to seek an in-person assessment. How a patient accesses care in the community can make a big difference in your overall healthcare spend. You need insights into how this solution chooses who or where to send patients, and how their referral process works. 

Some solutions don’t have any referral capability at all, while others may only offer a traditional referral process (i.e., “Go see this doctor—good luck!”). The solution you should look for is one that offers embedded care coordination support and guides the patient through the entire referral process. A comprehensive approach includes making appointments, transferring medical records,  ensuring the patient’s care is coordinated, and making sure patients are not only completing their visits but that they are seeing high-quality, low-cost,  in-network providers. 

Q: Is the solution geared toward achieving better population health outcomes?
Providing access to care is a step in the right direction, but if you are only addressing urgent or acute care needs you are missing an opportunity to decrease your healthcare spend. If you aren’t addressing population health issues, such as chronic disease management, disease prevention,  cancer screenings, and the social determinants of health, you are going to be spending a lot more in the long run.  

To have a meaningful impact on population health outcomes, the solution should deliver on three connected goals:  1) Maintain or improve quality and experience. 2) Positively impact the health of the entire workforce through a robust,  proactive, focused model of preventive care, and 3) Control your costs. The best solution is one offering primary care that addresses acute, chronic,  and preventive care needs within an interdisciplinary

evidence-based approach focused on improving overall health and wellbeing. The solution should proactively engage with your employees vs. waiting for employees to come to them.  

Lastly, consider how long it has been since this solution’s model of care was developed. Many new entrants to the virtual primary care space have only been around for a short time and rely on a slick tech platform to sell their services, but don’t have a robust, integrated, and proven care model that allows them to provide effective care. The best solution is one with a tested care model and an engaging, easy-to-use tech platform. Ultimately, a virtual care solution has to be able to both engage patients and deliver meaningful care.

Q: Is this solution equipped to leverage permissioned and available healthcare data in order to provide meaningful and personalized care to your employees? 
The ideal solution is one that can aggregate, and evaluate multiple data sources such as claims,  health risk assessment surveys, and electronic medical records to create actionable clinical insights for the provider and patient. But it shouldn’t stop there. 

The solution should enable providers to build deep, trusting relationships through proactive and consistent engagement with their employees. Meaningful, data-derived insights coupled with a  trusted relationship between the patient and the care team is the ultimate combination to affect behavior change, increase adherence, and achieve positive results.

PART 3: EMPLOYEE EXPERIENCE 

Q: Are employees able to follow up with the same providers with who they initially engaged and vice versa? To put it another way, are employees able to build long-term relationships with the same providers?
The relationship element is a key satisfaction driver for the employee experience, and being able to consult with and get care from the same consistent team should be a primary goal. Healthcare is complicated enough without having to repeat your medical history every time you get care or having to coordinate your own care among different doctors and specialists. Ideally, the right care is being provided to your employees without them having to seek it out themselves.

If the solution you are considering does not provide for a consistent, interdisciplinary care team that can actually follow up with your employees and build a relationship over time, you may want to reconsider your choice. A team that provides proactive, comprehensive care creates trust which ultimately leads to positive behavior change.

Q: Can this virtual primary care solution create a seamless healthcare experience for your employees? 
Companies can cobble together different vendors to support the various healthcare needs of their employees, such as physical therapy and mental health. However, this usually leads to a confusing,  disconnected system and experience for employees which results in reduced engagement. 

In fact,  studies have shown that offering more choices leads to increased anxiety and dissatisfaction. A solution that can integrate with your other healthcare vendors can be great. But ideally, you end up with a “one-stop-shop” approach that offers expanded, integrated primary care services, including physical therapy, mental health, and much more, all in a singular solution.  

Q: Are the current members or patients of this virtual primary care solution highly engaged? 
When considering a solution, look for (and ask about) strong engagement. The number of repeat users, utilization of the services, and patient satisfaction scores are clear indicators of the solution’s long-term ability to impact health outcomes. These measures also reflect whether a solution is providing a great member experience. Consistent, long-term engagement builds trust which leads to behavioral change.

PART 4: PAYMENT MODEL 

Q: Is the payment model for this solution aligned with the outcome you’re hoping to achieve?
If something sounds too good to be true, it probably is. A low PEPM (Per Employee Per Month) or PMPM (Per Member Per Month) fee is great initially, but often means, you will see bigger bills elsewhere -  such as from additional visit fees or in-person utilization of high-cost specialists and services. Further, a  low PEPM or PMPM with no ties to engagement or population health outcomes means there is no incentive for the solution to proactively engage in care. If you are looking to reduce your overall healthcare spend, solutions that rely on visit volume for revenue (like a fee-for-service provider) have misaligned incentives. The best solution is one with a  transparent payment model, and guardrails in place around performance and outcomes. This will give you the ability to better forecast spend, as well as peace of mind that the solution is incentivized toward creating ROI for you. 

Q: Has this solution demonstrated value or results from their model of care? 
A comprehensive model should be able to demonstrate tangible savings and better health results for their members. Metrics such as member satisfaction scores, utilization costs comparisons, preventive care measures, duration of care for high-cost areas such as mental health and musculoskeletal, and other health outcomes are all things you must be given access to during the evaluation process.
 

Joel Haugen is the Chief Product Officer at Crossover Health. Haugen has spent his career focused on product strategy and successful large-scale system implementations, with significant experience in aligning client needs with the right solutions. As the Chief Product Officer for Crossover Health, Joel is responsible for developing and executing the strategic product roadmap, including scaling the solutions portfolio from design and tech enablement to delivery and optimization. His scope is inclusive of Crossover’s comprehensive full-stack care delivery service that spans engagement, care delivery, payment, and outcomes. Connect Joel  Haugen