The Future of Virtual Care Services: A Payor's Perspective.

Abstract

Whereas majority of telemedicine services today are focused on minor acute clinical ailments, the true potential of virtual care models lies in their ability to improve access to chronic condition care for medically complex individuals. Virtual models focused on chronic condition management will require continuity of care and the availability of in-person evaluations when necessary. Such services are more likely to be delivered by community-based primary care and specialty physicians, rather than vendor-administered, which is the most common model today. Both Center for Medicare and Medicaid Services regulations as well as state mandates have been increasingly more favorable toward the reimbursement of virtual services, and as a consequence, we expect to see continued growth in the availability of reimbursement of these services. As reimbursement becomes more liberal, we will soon reach an inflection point where these services are available as a covered benefit for substantial proportions of individuals, and we will see more physicians offer these services to their patients more frequently. As providers gear up to offer these services, there are important operational, logistic, and clinical elements of care models to consider. Consumers, in contrast, will need guidance on the appropriate use of the virtual care delivery channel. We are at an important inflection point in the evolution of virtual care, and are excited about its prospects.