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:

1. Musculoskeletal (e.g., major joint and spine surgery)
2. Cardiovascular (e.g., heart attack or peripheral vascular disease)
3. Cancer (e.g., breast cancer, colon cancer, or lung cancer) 

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 33% (1,2).

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 the doctor. 

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 Help? 

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 blindness.  

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 starts. 

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. 

Summary 

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.

Sources: 

1. https://pubmed.ncbi.nlm.nih.gov/9722797/

2. https://www.fiercehealthcare.com/practices/89-americans-value-relationship-primary-care-doctor#:~:text=%22A%20recent%20Oregon%20study%20showed%20that%20for%20every,M.D.%2C%20former%20AAFP%

20president%2C%20said%20in%20an%20announcement

3. https://www.mgma.com/data/data-stories/how-long-are-patients-waiting-for-an-appointment 

4. https://www.cancer.org/cancer/breast-cancer/about/how-common-is-breast-cancer.html