March 03, 2021
1. After an explosion of virtual care use in 2020, employers are looking to drive value in their digital health approaches in 2021.
Large employers have pioneered virtual health strategies and coverage over the course of the past decade, though low utilization had been a constant challenge. All that changed in 2020 with the emergence of a global pandemic that kept people home and out of the doctor’s office. FAIR Health estimates that telehealth claim lines increased 3,060% nationally from October 2019 to October 2020 among the commercially insured.
In 2020, not only did the use of existing telehealth vendors increase, but a number of “home grown” options offered by providers who had previously never delivered virtual care emerged to make up for cancelled in-person visits and address the needs of their patients. Dozens of vendors with any sort of virtual care component approached large employers, pitching their services as tens of millions of employees transitioned to working from home in just a short few weeks.
If 2020 was a year to rapidly expand virtual health options in reaction to the pandemic, 2021 will be a year to do some pruning and landscaping to make sure that individual pieces fit together and are delivering valuable and appropriate care.
Virtual Health Becoming a Medium of Its Own
It took a decade or more for early cinema to become a “narrative medium in itself.” Before that, it was mostly used as a static way to document scenes or stage plays. Virtual health is similarly transforming from simply attempting to recreate an in-person visit mediated by a screen to something truly transformative and better. Employers and their partners are developing the tools to identify what is a leap ahead in virtual health capability and what is trying to create the “Before Times” with a computer screen (aka prior to late 2019).
This process will include:
- A strong push for integration across all providers, ranging from traditional brick-and-mortar clinicians (practicing in-person and virtually through their own systems,) telehealth vendors and condition-specific tools with remote monitoring elements, to wholly new approaches for providing care through chatbots, and artificial intelligence. It’s easy for an employee to get confused, overwhelmed or more treatment than they need when presented with so many ways to get care, virtually and otherwise. The situation is further complicated by lack of integration and interoperability, or even regular, transparent data-sharing across platforms. In addition to confusion, an unintended but likely outcome is duplicative, uncoordinated care that results in waste, excess cost and perhaps subpar treatment.
- Movement toward reimbursement for virtual health via value-based arrangements. In the immediate aftermath of the pandemic, employers and health plans were paying for virtual health visits on-par with in-person visits to help eliminate barriers or friction for employees seeking care. Almost a year later, employers have a healthy skepticism about whether some virtual care is as effective as in-person visits; as a result, many will look to require value-based elements to virtual care reimbursement if payment parity is to continue.
2. Employers will keep an eye on equity as they innovate – and demand their partners do the same.
In 2020, a necessary reckoning on race accelerated after several high-profile killings and the significantly greater impact that COVID has had on minority groups. Investors have begun to take seriously the lack of diversity in the ranks of leadership in startups and the effect it has on what they create together. While employers have worked toward the longstanding goal of ensuring that all employees have an equitable opportunity to achieve their full health and well-being potential, the pandemic has exacerbated existing challenges and elevated this priority.
With a bright spotlight now shining on disparities in health access and outcomes, employers have turned to their data, looking to identify gaps and opportunities. Discussions between leading employers on the Business Group’s Health Innovations Forum and emerging health care vendors have increasingly focused on how their programs cater to diverse employee populations, incorporate culturally competent elements and reduce disparities in outcomes. Likewise, employers have refocused their own internal efforts to innovate in the workplace, beyond traditional diversity programs to thinking more holistically about how each of their strategies will impact unique communities in their workforce. Expect to see a greater emphasis and additional scrutiny on impacts of health and well-being program approaches on equitable outcomes from employers as they look to innovate internally and with external partners.
3. The case for infusing mental health across employers’ health care strategy will be bolstered beyond recent efforts by employers to integrate mental and “physical” health approaches.
The need for mental health assistance is sky high in 2021 worldwide. Multiple telemental health providers report 2020 utilization up 50%-300% compared to 2019, with increases sustained across the year as COVID-19 cases reached additional peaks and lockdowns remained widespread. Long-term negative impacts of the pandemic on pediatric mental health, substance use disorder, depression, anxiety, suicide and other mental health challenges are already revealing themselves for both people with preexisting conditions, as well as those with generally good mental health in 2019.
While employers have for years sought to increase mental health services for employees and encourage partners to consider how their programs impact mental health, heading into 2021, expect to see more employers embracing a “No Wrong Door” type approach to mental health. In practice, this means that employers are increasingly infusing mental health services across their benefit plans, so no matter how an employee interacts with their benefits or health programs, they will be able to get mental health support on the spot or be one referral away from it. Never has it been easier for a benefit professional to make the case to leadership that mental health must be a more comprehensive focus of the organization than it is in 2021.
4. Flexibility is the name of the game for “workplace” expectations and vendor implementation.
What the balance of 2021 will look like is anyone’s guess given the fluidity regarding vaccine rollouts and school openings, not to mention when we’ll return to some sense of pre-2020 normalcy, if ever. Employers and their partners will need to be nimble to evolve and iterate quickly as the world changes once again during this next phase: the end of the worst of the pandemic and related lockdowns.
- Employees now have different expectations for their relationship with work and balancing it with their home life, which blurred for millions of people in 2020. For many employers, productivity increased with workers at home avoiding commute times and those still on-site often working harder to achieve pre-pandemic results with fewer healthy and present coworkers. Long-term impacts on burnout, productivity and employee satisfaction remain to be seen; they will likely differ by industry and company. Employers will need to be innovative and flexible with how they structure the workplace so that employees can achieve some balance in 2021 and beyond.
Virtual/Digital Health Formularies
“Virtual-first” primary care was a promising idea in 2019 during scattered pilots, but in early 2021, it is almost assumed to be a model for health care delivery going forward. In 2021 and 2022, expect to see employers implement more sophisticated virtual or digital health formularies that incent employees to use proven virtual health services before considering in-person alternatives.
- One silver lining of a really tough year is that traditional barriers to implementing change have been brought down and are unlikely to ever come back in the same way. Fee-for-service medicine failed thousands of providers who were reliant on in-person utilization of their services, forcing them to embrace telehealth faster than ever. Procurement processes, long a headache for HR and their industry partners, were streamlined for many employers who needed solutions quickly for a distant, ill and stressed workforce. Leave programs evolved overnight as schools closed and workers with any symptoms of sickness were sent home. There is little reason to believe that the workplace will ever go back to what it looked like in 2019; successful employers will reexamine their policies as 2021 unfolds.
Given how quickly 2020 took a big left turn just a few weeks/months after it began, it remains to be seen the extent to which these “2021 Trends to Keep an Eye On” will materialize as the year unfolds. However, the Business Group’s experience with engaging leading employers, partners, investors and experts gives us confidence that these trends will gain steam this year and are worth watching by anyone interested in employer approaches to innovation.