Virtual primary care is a strategy to improve
employer-sponsored health plan members’ well-being and lower claims
costs. Aside from expanding access to care that is cost-efficient and
reliable, why should an employer offer virtual primary care to employees? Let’s
begin by analyzing employer and employee health challenges.
Drivers of Poor Employee Health and High Claims Costs
Poor employee health and high health plan costs are concentrated. 5% of health plan members drive 50% of health plan costs. Additionally, 20% of health plan members drive 80% of health plan costs. These health plan members have more than $50,000 in health care costs per year.
These high-cost claimants typically fall into one of three diagnostic categories:
- Musculoskeletal (e.g., major joint and spine surgery)
- Cardiovascular (e.g., heart attack or peripheral
- Cancer (e.g., breast cancer, colon cancer, or lung
When we examine the claims of these individuals, we frequently find that they had very few to no claims before their catastrophic health event. Most did not crescendo over time to become high-cost claimants but just blew up out of nowhere.
Why is that?
Low Primary Care Utilization
60% of US adults have not seen a
primary care physician in the previous 2 years.
As a result, untreated arthritis and
back pain lead to major surgery and large musculoskeletal claims. Untreated
diabetes, hypertension, and high cholesterol lead to large cardiovascular
claims. Undiagnosed small cancers from lack of screening become advanced stage
and metastatic cancer.
Conversely, primary care has been
shown to lower the probability of death by 18% and lower healthcare costs by
If primary care is so great, why don’t employees use it?
Inconvenience and Poor Access Drive
Low In-Person Primary Care Utilization
Going to a doctor’s appointment is
incredibly inconvenient. Patients must travel there, fight traffic, park, wait
in a waiting room and wait in an exam room for what often amounts to only a
5-to-15-minute visit. The process of seeing a doctor takes half a day. Patients
must take time off work and often arrange for childcare to make the visit
possible. The hassle is just too much for many patients, so they don’t go to
It is difficult for those patients
who want to go to a primary care doctor to book a new patient appointment. In
major cities in America, a patient must wait 24 days for a new patient
appointment. In mid-sized cities, it’s even worse— a patient must wait for an
average of 32 days (3).
How Can Virtual Primary Care
Virtual Primary Care Diagnoses and
Treats Diseases Early Before They Become Catastrophic
Virtual primary care doctors can
lower musculoskeletal claims by treating arthritis with non-narcotic pain
medication, referrals to in-person physical therapy, or weight loss counseling.
Additionally, many people with chronic pain from arthritis also have mental
health challenges such as depression and anxiety, complicating their medical
disease. Virtual primary care doctors can diagnose and treat depression and
anxiety as well.
Virtual primary care doctors can
diagnose and treat diabetes to stop cardiovascular disease, kidney failure, and
Diabetes is diagnosed via a blood
glucose test that can be ordered by a virtual primary care physician and
completed by the patient at a local in-network lab such as Quest or LabCorp.
Diabetes treatment includes long-proven, low-cost generic medications such as
metformin and glipizide. Diabetes control is measured over time by another
blood test called Hemoglobin A1c, which the virtual primary care physician can
also order from a local lab.
As important as lab testing and
medication, virtual primary care allows doctors to have longer and more
frequent visits with diabetic patients to counsel them on diet, physical
activity, weight loss, and warning signs for their disease.
A person can live many healthy years with diabetes—and it can even be reversed—through monitoring, medication, and lifestyle modification. Finally, virtual primary care physicians also coordinate the US Preventive Services Task Force cancer screenings to catch and remove pre-cancerous growths and treat cancer sooner while it is still curable.
Virtual primary care doctors refer
patients based on age to gastroenterologists for screening colonoscopies. Not
only does a colonoscopy screen for colon cancer, but the procedure can remove
pre-cancerous colon polyps as well. Colonoscopies stop cancer before it
Additionally, virtual primary care
physicians can order mammograms at local, in-network imaging centers so that
women can be screened for breast cancer. 1 in 8 women will develop breast
cancer, and half of all breast cancers occur in women under 62 (4). Therefore,
women must be screened at the appropriate age and frequency to catch breast
cancer early while it is still curable.
Employers can make a difference in
the lives of their employees and their families and lower healthcare costs
simultaneously. Primary care is the key, and Virtual primary care is a
fantastic way. TelaCare can help employers provide virtual primary care to
their employees at a fraction of the cost.