While there are recent reports that the volume of telehealth visits has fallen, it’s clear that seeing a doctor via phone or video has now become a viable and long-lasting way to deliver care. The key for healthcare providers and health plans going forward is determining what care should still be done in person, what can be done virtually, and ultimately, who will pay for it.
“Blue Shield of California was already on the path to making care more accessible to our members including using telehealth technologies,” says Bryce Williams, vice president of MindBody Medicine at Blue Shield of California. “The question is, as we get closer to our new normal, where virtual care was by necessity during COVID lockdown rules, what does virtual care by choice look like?”
In addition, how should providers offering virtual care be reimbursed for that care? While brick-and-mortar medical offices might charge the same for a video appointment as they do for an in-person visit, is the patient receiving the same value of care? Should a doctor’s visit online cost a patient the same co-pay?
Answers to those questions will take time to flesh out, but no doubt people want more remote care in the wake of COVID-19, notes Rebecca Picasso, principal program manager of Virtual Care and Telehealth Innovation at Blue Shield of California. Areas such as primary care, specialty care, and mental health all show great potential.
“People want coordination of care with their own providers, but they also want on-demand care, so a hybrid model is most likely what is coming in the future,” Picasso says.
A Work in Progress
The industry is well on its way to a hybrid model. According to a Blue Shield of California/Harris Poll survey of 1,000 adults conducted in February 2021, about half (49%) of Californians said they had a telemedicine visit during the pandemic, while 39% said they had done so before COVID-19. And 82% who used telemedicine were satisfied with the service.
As a health plan, Blue Shield of California has insight into how providers and members use virtual care. Analyzing utilization, telehealth usage is on track to meet or exceed 2020 levels, which were up nearly 2,100% from 2019.
With this new-found acceptance of virtual care, Blue Shield has been working to build out various platforms and services to harness the power of telehealth for its members.
Some efforts include:
- Mental health visits. Blue Shield has expanded its platform with Teladoc to include the provider’s mental-health network of therapists online. Utilization rates with Teladoc for mental health visits climbed steadily over time, to 3.5% in April 2021, up from just 0.3% a year earlier. In April 2020, Blue Shield expanded its Teladoc Mental Health to include all of its commercial accounts, leading to an 21x increase from 2019 to 2020.
- Rural health visits. As part of Blue Shield’s Health Reimagined initiative, there has been an opportunity for members and patients in rural communities to connect with specialists without having to travel long distances for multiple appointments. Primary care doctors upload patient information to a platform that can be accessed by the specialists and can quickly render a diagnosis and treatment options, drastically reducing the time it takes to deliver care. From there, the primary care physician and specialist can collaborate on a treatment plan with the member.
- Kidney disease patients. Blue Shield has continued its at-home and telehealth care options for its members with late-stage chronic kidney disease through a collaboration with Cricket Health. This gives members choice in their treatment plan, allowing for virtual visits, as well as support from peers and a team of medical experts. Overall, Blue Shield claims data showed the demand for telehealth for specialists grew 40x from 2019 to 2020.
With all of these initiatives, Blue Shield of California sees technology as the key to offering more products and services as part of a greater virtual-care network, giving patients in the market a preference of the way they want care delivered, notes Heather Blanchard, a senior director of program and project management of medical care programs at the organization.
“We are working to offer more cost-effective options to segments of the market, giving members the choice of a virtual plan instead of a brick-and-mortar one,” she says.
While much still needs to be worked out, telehealth has shifted medical care for the better, according to Picasso.
“Telehealth provides that jump in initial care, especially with people who typically wouldn't access care or wouldn't access care frequently,” Picasso says. “Now that they have that access, they're going to use it.”