UnitedHealthcare Expands Virtual Care Policy to Boost Primary Care

In an effort to encourage virtual care and primary care services utilization, UnitedHealthcare is expanding its virtual care policies so that more members can have access to virtual care visits as an alternative to in-person visits.

“The UnitedHealthcare Virtual Primary Care service and updated policy helps expand the use of virtual care from delivering care to people who are sick, to now also focusing on preventing and detecting disease before it starts and, if needed, helping people more conveniently manage certain chronic conditions,” said Anne Docimo, MD, chief medical officer, UnitedHealthcare.

“As more people and care providers move to a digital-first mindset, UnitedHealthcare will continue to modernize our approach to health benefits and invest in new ways to use technology to help make it more convenient for our members to access primary care and other types of medical services.”

Under the current policy, employer-sponsored fully insured or self-funded health plan members in 11 states can leverage virtual care for certain services instead of receiving care in person. Those states are Arizona, Colorado, Illinois, Maryland, North Carolina, Ohio, South Carolina, Texas, Virginia, Washington, D.C., and West Virginia.

The updated policy extends this option to members in more states in 2021. The update went into effect on January 1, 2021. Members of fully insured and self-insured employer health plans are eligible for this offering.

UnitedHealthcare partnered with a national telehealth provider group to offer this option. Members can use a mobile device or a computer to access virtual care.

The Virtual Primary Care service allows members to access key primary care services through virtual care.

For example, members may set up an annual wellness visit or an appointment for minor sicknesses through virtual care. They could also receive follow-ups and checkups regarding chronic conditions. With this service, members can also receive specialist referrals or order lab tests and see the results via virtual care.

Providers can also write out prescriptions for the member through virtual care. However, the press release qualified that not all prescriptions are available through this service and there may be certain restrictions on this capability.

Members will shoulder little to zero cost-sharing in the Virtual Primary Care service, UnitedHealthcare added.

In addition to joining the movement toward digitization, the policy update is in response to a decline in primary care utilization. A shift in primary care utilization began even before the coronavirus pandemic drove members away from doctors’ offices and in-person care, according to a recent study published by JAMA Internal Medicine.

The relationship between a primary care provider and a member is pivotal for lowering members’ low value healthcare spending. Thus, encouraging members to find a primary care provider is a key priority for payers.

Using virtual care or telehealth services to boost primary care utilization has become a popular strategy among payers and providers, particularly during the pandemic.

In a Health Research Institute survey, 92 percent of provider participants were using telehealth for primary care services. In particular, they leveraged the technology for follow-up appointments and ongoing care management.

UnitedHealthcare has also tried to increase primary care utilization through plan design. In California, the payer launched a concierge-style health plan with free primary care as well as free urgent care services.

“In designing the California Doctors Plan, we wanted to not only offer significant cost-savings but also a more personalized, simplified and coordinated care experience that can help people improve their health and well-being,” Steve Cain, chief executive officer of UnitedHealthcare in Northern California, explained at the time.

The announcement of UnitedHealthcare’s Virtual Primary Care service comes shortly after the payer’s parent organization, UnitedHealth Group, revealed an important acquisition.

The payer will be purchasing Change Healthcare and combining it with its subsidiary, Optum. UnitedHealth Group will spend approximately $8 billion on the deal. The parties are waiting for the necessary approvals to move forward.