Options for Ensuring Care

Virtual Care

If it has some control over healthcare plan design, the company can use that as a tool to increase access. One way is to ensure that telehealth visits for medical and behavioral healthcare are included in its benefits. Those visits should be low cost to encourage people to use the services. Some insurers offer telehealth directly through their health plans for little or no co-pay. If that isn’t an option, external providers like Teladoc, MinuteClinic Virtual Care, and Talkspace all accept insurance.

Using these kinds of services to connect people to primary care and basic behavioral healthcare increases the use of preventive services and tends to keep patients out of more expensive (and shorter-staffed) emergency rooms, specialty care providers, and hospitals.

Ask About Accessibility

It is also imperative that employers look at their plan designs—particularly if they are closed plans or narrow networks—to ensure there is sufficient access for beneficiaries, says Jan Berger, medical director of the Midwest Business Group on Health (MBGH). MBGH is a nonprofit that helps employers manage their healthcare costs and improve employee health.

“Employers shouldn’t just be asking how many doctors they will have contracts with [in their plans], but they should be asking how many new patients those doctors are taking and what the wait time is to get into those offices,” Berger says.

Several years ago, Berger worked with an employer that had a closed network for women’s health and pregnancy services. The group included high-quality providers, but only two OB-GYNs who were taking new patients across a large metropolitan area.

She also worked with an employer in Chicago that had a closed pharmacy network that included only CVS. When CVS employees went on strike, there was no way for patients to get their medications.

MBGH Vice President Dawn Weddle says employers should consider adding physician access as a key performance indicator (KPI) on health plans. Employers can ask for plan metrics on access on an annual basis and require backup plans if the network isn’t sufficient.

“Employers are accustomed to KPIs on vendor contracts,” she says. “One way to hold insurers accountable, and have some skin in the game, is to put a percentage of their fee at risk if they don’t have enough providers seeing patients in their plan. There is no reason that access can’t be one of their KPIs.”

Understanding Need

With much of the workforce still working virtually or on hybrid scheduling as the COVID-19 pandemic recedes, it’s important for an employer to understand its employees’ health issues and access to care. When employers do that, they can look to options like direct contracting, urgent care programs, or on-site or nearsite clinics to increase access.

For instance, if an employer has a widely dispersed population, it might consider partnering with organizations that can fit that need—for example, MinuteClinic, which has locations in many areas; or VillageMD, which offers in-office care by some Walgreens stores and has a robust virtual platform for reaching providers through virtual visits, telephone, and text messaging.

Berger also recommends gathering insurers, pharmacy benefit managers, and any others that deal with mental and physical health to work on the issue of access. A vendor summit where all parties are at one location to work out problems can be beneficial, even for small companies with a handful of vendors, Weddle says.

“It’s much more effective if everyone is in the room because these can be tough conversations,” Berger adds. “I had one where I was with a PBM working on disease management. A large employer literally locked us in the room and said, ‘You are here as vendors of this company, and you work for us.’ And we had two days where they would pick problems, and we would meet to work on those issues.”