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During COVID, patients and healthcare providers were forced to opt for virtual care, even if it wasn’t their preference. Since then, the virtual care model isn’t limited to urgent care; it has really expanded to find it’s place in a wide swath of  healthcare specialties. Now with five years of practical experience, research confirms the effectiveness of this new practice.

Though favored by many patients, telemedicine is nevertheless an underused modality. With the potential to transform modern healthcare, understanding the benefits of telemedicine – why it’s important and how it’s affecting patient experience – is a critical issue for employers and benefits administrators to grapple with this year.

Data Reveals a Harsh Truth

Calculating transportation time and waiting for in-person visits adds up to significant lost productivity and lost wages, which affects both employees and employers. In one study, telehealth visits saved patients an average four hours saved – per visit.  Another study documented 11,000 cancer patients that collectively saved 30,000 hours and 3.8 million miles in 14 months. These are big numbers.

Consider also the costs of vehicle wear and tear, risk of car accidents, exposure to contagious illnesses, and greenhouse gas emissions, which are all reduced when patients take advantage of telehealth options.

In terms of saving money on the care itself, findings universally demonstrate that access to virtual care lowers the overall costs. One study reported that visits with 24-7 copayment-free telemedicine programs were 23% less expensive than in-person visits for the same conditions. As an employer with claims utilization metrics affecting renewal increases, this is not insignificant. Redirecting care from emergency rooms and urgent care centers to telehealth saves between $309 and $1,500 per visit, but cost savings are there for routine visits as well.

Between social impact, premium cost increases, worker productivity and the very real cost of care, telemedicine has economic effects that are getting noticed. In fact, telehealth is seen as an essential healthcare option by employees. For employers to be competitive in their recruiting and retention strategies, they need to have virtual care options included in their benefits package.

But, How Does It Work?

While there are many telehealth vendors, CloseKnit Health is a completely virtual (also known as virtual first care, or V1C) provider practice that has been part of the CareFirst benefit plan since 2021. Care through CloseKnit is available to every CareFirst member (not an add on) and a free CloseKnit smartphone app helps make the services easily accessible when and where it’s needed.

All the services of an in-person provider practice are available with virtual care, including appointments, referrals, doctor’s notes and prescriptions. Indeed, in-person care is always available to Carefirst members even if they’ve chosen to try CloseKnit virtual care.

CloseKnit benefits are completely virtual and in-network. Wherever you are – at home or away – patients are paired with providers that can write prescriptions in the state where they are located. And, urgent mental and physical care will always be addressed by in-network providers, regardless of the member’s specific medical plan.

While some employers may be just a little intimidated with trying a new tech-based service, the oldest Closeknit patient in 2024 was 94 years old! This speaks volumes about the accessibility and ease of use.

Available When & Where You Need It

Virtual care services are available to help patients manage their healthcare in every capacity – from urgent, one-time needs to coordinated routine care and management of chronic conditions.

Urgent Care | Often, urgent care is the first time a patient experiences virtual care. It may happen during a holiday, weekend, or vacation where the patient’s providers are not available to help address a medical concern.  Serving patients as young as 2 years old, CloseKnit urgent care is available every day and at all hours for 24/7/265 accessibility. The goal is to get the patient triaged, treated, and moving on with feeling better as quickly as possible – it takes roughly 10 minutes to be connected with an urgent care provider.

Primary Care | For more routine medical attention, CloseKnit primary care is provided to members 18+ through a dedicated practitioner chosen by the patient, with appointments scheduled within a few days anywhere in the U.S. and at any time – so as to be convenient for unconventional schedules and locations. Bluetooth-enabled kits help providers remotely administer preventive care assessments and monitor chronic conditions, and a chat feature lets patients text with their care team to ask for prescription refills or follow up questions. The chat plus urgent care through Closeknit does an amazing job at helping to keep patients out of the emergency room (unless it’s for a true emergency.)

Mental Health | When patients aren’t sure how to get started with mental health therapy, an optional survey is available to help orient them. First appointments may take three-to-four-days to schedule. After the initial consultation, a treatment plan will be set with regular appointments for the appropriate duration.

Short-term therapy based on Cognitive Behavioral Therapy (CBT) typically lasts for 8-12 weeks. CloseKnit patients who completed short-term therapy have reported seeing their anxiety decrease by 63%, depression down by 61%, and stress down by 49%.

Long-term therapy can go for as long as the patient and therapist deem necessary to address complex mental health issues like ADHD, trauma, or substance abuse. A psychiatrist would join the care team if any type of medication management is needed.

And More | After choosing a primary care provider, a nurse practitioner and other CloseKnit providers will coordinate to ensure that everything is working the way it should behind the scenes for your medical wellness, mental health care and coordinating prescriptions. Additionally, parents can schedule appointments with a lactation consultant, a doula, a nurse, or a prenatal therapist. Behavioral therapy and urgent care are available for children, and nutrition services help provide evidence-based guidance for members ages five and above.

Conclusion

We know that the average number of Closeknit primary care visits is 6 per year, with additional support through the chat, and we can see that the utilization and coordination of care has been at its highest levels in 2024. With new reporting coming out next year, we’re interested to see how the data matures shows how virtual first care is impacts healthcare at large.

Despite being underused, virtual care is extremely valuable. The patient/provider relationships that can come about when you remove the barriers to accessing care help are essential to building a healthier workforce.

Ultimately, at every level of the healthcare supply chain – insurance carriers, benefits brokers, providers, employers, and end-users – we all need to be creative about ways to contain costs while still supporting health and wellness.  So, how can a health insurance carrier provide you with solutions that bring competent and quality healthcare to your employees?

Rising Costs

Employers and employees alike rank health-related benefits as the most important offered – more than paid leave, financial incentives, and retirement planning – and this value is shown in a positive ROI. In 2022, employer sponsored insurance (ESI) drove $275.6 billion in improved productivity, $101 billion reduction in direct medical costs, and $119.2 billion in tax benefits. Additionally, post-pandemic changes to health-related employee benefits include adding valuable services like telemedicine (93% of surveyed organizations) and mental healthcare (91%).

Healthcare costs have outpaced rates of inflation for decades, and we’re expecting this growth to continue, ultimately totaling nearly 20% of the U.S. economy by 2029. Data from the Centers for Medicare and Medicaid Services (CMS) indicate an increase in health spending tripled between 2000 and 2022 to $4.5 trillion. While multiple factors contribute to this growth, often cited are an aging population, labor pressure, and new high-cost prescription drugs.

In fact, we can see the cost of care increases reflected in the rising insurance costs over time with the average per-employee cost reaching a record high in 2023. Developments in the pharmaceutical market are apparent, with the pharmacy benefit cited as the fastest growing component of plan cost. Large employers have been mitigating these increases by increasing deductibles and out-of-pocket maximums, but this trend is difficult for the mid-size businesses to manage, as they’re subject to certain regulations but tend to have less ability to allocate additional resources to their employee benefits package.

What is Max Performance Plus?

Carefirst launched Max Performance Plus on June 1, 2024 as an add-on to a fully insured benefit that allows employers to receive a surplus of net-billed premium not used over the plan year. It’s essentially a funding mechanism that allows you to take a fully-insured product and adds the potential to receive 100% of the surplus, up to 15% of the net premium, at the end of the contract period.

The Max Performance Plus program carries a higher risk premium charge (a.k.a. retention item) and can be sold with any fully-insured Carefirst medical or prescription drug plan. It’s not a separate plan, it’s an add-on to the Carefirst fully-insured product portfolio. While you cannot cancel mid year, you can opt to remove the Max Performance Plus product at renewal and still continue with your fully-insured plan.

In contrast to a self-insured product, Max Performance Plus takes your current fully-insured product and adds a performance element. Many groups want to know how they are performing as a group. By adding Max Performance Plus, employers get the reporting function for more information about performance, while getting surplus back as a payment.

Remember, with a self-insured plan, the employer pays claims beyond what insurance will cover, up to a pre-set amount. Performance reporting allows groups to track that claim activity. Mid-size groups 50-150 employees are often not able to take full advantage of all of the self-insured product’s benefits, and these plans calculates surplus potential as a percentage of an administrative credit.

Surplus Payment

It typically takes 60-110 days to finish paying claims after the end of the plan year. At that point your surplus payment is given as a check or electronic funds transfer – not just a premium credit. Groups are eligible to receive their surplus payments as long as they remain in a fully-insured product with Carefirst and have paid in full – even if they decide not to renew the Max Performance Plus program. Deficits do not affect the surplus payment, nor do they carry forward.

Reporting

Groups of 51-99 employees using this program will have access to monthly reporting features they wouldn’t otherwise have on a fully-insured plan; Executive Summary and Account Experience Reports are easily access via the employer portal under Account Insights. Larger groups, which previously had access to reporting, will also see additional performance data around demographics, cost analysis, utilization, site of care, high-cost claimants and pharmacy use. The reporting data gives employers information that can help inform and educate employees about more cost-effective healthcare choices, such as the value of in-network providers and avoiding expensive ER visits for urgent care needs.