Aetna's Virtual Primary Care Plan Could Be Industry Trendsetter

by Peter Johnson

Aetna, the health insurance arm of CVS Health Corp., has launched what it calls the first national health plan built around virtual primary care. The benefit design, which is a further expansion of CVS's longstanding relationship with virtual care provider Teladoc Inc., will be available to self-funded plans.

According to a CVS press release, the new plan is designed with an emphasis on continuity of care and convenience, starting with "a continuous relationship with a virtual care physician beginning from the first 30-45 minute comprehensive primary care visit and extending to every visit thereafter," and it promises "timely primary care appointments."

Virtual primary care is a starting point:

• "Virtual-first is a plan design [that's] not hard to figure out when you have doctors available," says Steve Blumenfield, head of strategy and innovation for health benefits at Willis Towers Watson.
• "The question now is, this kind of digital platform — is it going to be a cornerstone of all the health plan offerings?" asks Ashraf Shehata, KPMG's national sector lead for health care and life sciences. "Virtual primary care lends itself to being the sweet spot of the virtual platform." Shehata expects that could be a "common starting point" for health plan benefit design going forward.

The key to success:

• For both Aetna and the broader payer industry, "telehealth will be an important part of the health benefit going forward with a mix of those outsourcing and insourcing the capabilities," Citi analyst Ralph Giacobbe wrote in an Aug. 11 note to investors. "The ability to offer telehealth in conjunction with onsite care, and particularly ability to steer volume, will differentiate success around telehealth strategies, in our opinion."
• The key to the success of the offering, Blumenfield says, is whether it will reduce costs for plan sponsors — adding that most plan sponsors have a virtual care benefit already.
• Blumenfield and Shehata also emphasize that plan sponsors will have to strike a balance between continuity and steering members to cut costs.

From Health Plan Weekly