The Evolution of Virtual Care

Speaker 1: (00:09)
Welcome to insights on innovation for self-insured employers. It's a series that matter produces together with trust mark, uh, I'm Stephen Collins, I'm the CEO of matter. We are a healthcare technology incubator and innovation hub built on a premise that collaboration between entrepreneurs and industry leaders is the best way to develop healthcare solutions. Today, we are here to discuss the evolution of virtual care about 40% of consumers say in surveys that they believe telehealth will be a part of their healthcare journey in the future, compared to just 11% prior to the pandemic and 60% of physicians view telehealth more favorably now than they did pre pandemic. The shift to virtual care, that's been accelerated through the pandemic, presents a set of challenges and opportunities for self-insured employers and employees. And we've got a great group with us today to discuss what's on the horizon. Uh, Paul ska is the chief growth officer of Trustmark.

Speaker 1: (01:16)
Uh, before joining the company last year, he spent 22 years at HCSC most recently overseeing strategy innovation and delivery of market solutions for their large national accounts. Uh, Janet fair cloth is senior vice president of health innovation at Aon. She's been with the company for 30 years and is focused on the development of next generation healthcare and benefits strategies. Uh, Rob Brer, senior vice president and general manager primary care at Teledoc. He joined company in 2013 and is responsible for the overall direction of their primary care solution. Our moderator today is Christopher Paquette, who is the chief digital and strategy officer at Trustmark. Christopher was a partner at McKinsey before joining Trustmark last year to lead their digital and analytics strategies. Uh, so with that, uh, Christopher let's get started.

Speaker 2: (02:16)
Sounds great. Thanks Steven. So I'm, I'm really excited about this topic today, and I know our panelists are as well. Uh, thanks everyone for joining. Um, and let's dive in. Uh, so I think we'd be remiss to, you know, talk about a solution without understanding the context. And so, you know, Janet, maybe you can start us off with, um, explaining some of the macro factors that you see that are driving changes and innovation and healthcare and employee benefits today and how those affect virtual health. What are you seeing from your role?

Speaker 3: (02:46)
Yeah, thanks Christopher. I think when we look across the landscape of everything that's happening, we really see five key forces that we believe will be shaping the future of benefits. And they increasingly have urgency for employers to address when we're in this really tight labor market, at least, um, in the short term. So the first one is that employee expectations are expanding and it's natural as the workforce is becoming more diverse, uh, work models are evolving and, um, there's more, you know, opportunities for a remote and flexible work. So we're also seeing that a key expectation among employees coming out of the pandemic is that their employers will support them with their entire life experience and not just their work life. Um, this, the second factor is that unfortunately health and wellbeing is declining. It's another legacy of the pandemic. Um, that employee wellbeing has really taken a big hit, but at the same time, employers are really seeing that connection between healthy employee healthy and resilient employees and the performance of their business.

Speaker 3: (03:43)
Um, so a bigger focus on, on really improving health and wellbeing. Uh, third one is the focus around D E and I it's a priority for most CEOs. If you look at surveys, um, and employers are really increasingly focused on, um, how they can assure that their benefits programs are also advancing their de and I goals. Um, when we're talking about defining health and wellbeing, the data is really showing that, um, it's really been worse for young people, for women, for people of color. So health equity is definitely one of those key areas of focus. Um, the fourth factor is the affordability pressure. I mean, we've been talking about healthcare costs for years. It seems like the, the trend numbers never actually changed that much. Um, and unfortunately, a key strategy for employers over the years has been to cost shift more to employees, but we're really reaching a point now where the cost of healthcare for employees and their families is becoming increasingly a barrier for them to getting the necessary care that they need.

Speaker 3: (04:39)
Um, and then finally there, there's a bright spot in all of this that there's a significant amount of, of market, um, innovation. And we'll be talking about, uh, some of that today. Um, so there's new solutions from startups as well as some traditional market players, um, to address some of these challenges. And so really it, when we think about virtual care, um, the collective effect of these trends is to really broaden the lens on the ways that virtual care can support and employers benefits and workforce goals. Um, we're really at this point now where we can start to move away from thinking about virtual care is just another like cost savings tool. And think of it more as a way to help address this variety of complex challenges that I was just talking about. So we think about it in the context of, of a, a new solution like virtual primary care.

Speaker 3: (05:26)
It can really address all five of these staffers. It meets that increasing employee expectation to be able to do everything from anywhere. Um, it helps improve, you know, employee health and wellbeing by having them more engaged with primary care on a longitudinal basis. I can advance health equity by filling in gaps and access to quality healthcare, um, in the cost of care, you know, lowering cost for employees, um, and employers. And it can really LAR be a, a tool to leverage that market innovation. I was talking about by, by using the technology that's inherent in virtual primary care to integrate new solutions that are important to employers into care delivery.

Speaker 2: (06:03)
Yeah. Well, great answer. Thanks. It is, uh, clearly that there's a lot going on. That's shaping the market, uh, driven by pandemic and, and other trends in DEI and cost and innovation. Um, you know, that you've just talked us through, you know, Rob, if, if maybe we just for a minute took kind of a, a double click on the employer lens, you know, in your front row seat at Teledoc, like, what are you hearing from employers? How do they think about these types of trends? How do they think about virtual care as a solution to them?

Speaker 4: (06:31)
Sure. Thank you, Christopher and good afternoon. Good morning, everybody. I think Janet gave a great setup there and customers said maybe I'll double click on that a little bit. Um, you know, to, to emphasize Janet's point, obviously nothing novel that it all sort of centers around and, and comes back to access quality and, and cost. But you know, what we're seeing is this really exciting evolution where the scope and the responsibility of virtual care has expanded so dramatically, especially over the past, you know, 18 months as folks have become more aware and there's more investment in this space. So it's gone from, uh, you know, a space where you've had some point solutions solving, urgent care type of needs in certain circumstances, uh, going a little bit broader than that. But of course, as I said, in, in sort of the recent period, the scope and, and the depth of what virtual care can really address is has, you know, increased by, you know, an order of magnitude.

Speaker 4: (07:19)
So virtual care has, you know, from an employer's perspective, become a really material investment and something that requires like a proper strategic thinking, a proper plan as, as they really begin to blend together the virtual offerings with the bricks and mortar offerings that they, they put in front of their beneficiaries. Uh, more specifically, I guess I'd highlight, you know, in the face of that three key trends that we're really, you know, watching and, and three things that we're really building our solutions around the first is, you know, um, if I think back the past five, 10 years ago, as you said, my introduction and joined Teledoc in 2013, so I've had a front row seat to this, to this evolution. You know, we've gone from a few players in the industry to literally a few hundred. So the need to really have a sole source single source for both the purchaser.

Speaker 4: (08:02)
And then how that gets passed on to the user is really critical. It's easier for the buyer to manage, but it's also easier, frankly, for the end user to navigate when it all sits behind that one single front door. The second theme that we're gonna talk a lot about here today, and something that I I'm, you know, really passionate about as we think about primary care in particular, is that there is no standalone bricks and mortar model, and there is no standalone virtual only model. We believe that will be truly successful. We have to create a hybrid ecosystem where an individual goes sort of seamlessly frictionless in a frictionless way between those different touchpoints and makes it such that, you know, those vendors or that sole partner are really working closely hand in hand to break down as many of those barriers that create kind of friction for the individual as possible.

Speaker 4: (08:44)
And that's a theme we'll talk about a lot more today. Um, and then the last one that I know that, uh, obviously this group is collectively very excited about and something we're seeing as a really macro trend in the market is that, you know, benefit design and the vehicle, the, the benefit product, the carrier product needs to, you know, work even harder for, uh, the employer for the member and the ways in which virtual care is really being, uh, embedded into that offering. Um, you know, the, the sta I'm gonna give here is not a tele sta, this is a third party statistic, and that is in the coming year, about 15% mid or large employers will offer some version of a virtual first health plan. And another 20% are looking at that, uh, to at least offer in the relatively near term. And that kind of to bring full circle points to the fact that obviously there's a belief that it's gonna expand access. There's a belief that it's gonna drive down costs and it's, you know, overall going to ultimately drive better quality and better outcomes. Cause we're really, you know, delivering expanded access to prevention and wellness and all the benefits that, that come with primary care. So really excited to talk about those three themes, uh, today and Chris FRA guess I'll, I'll pass it back to you.

Speaker 2: (09:46)
Yeah. Thanks Rob. Um, Paul what's, what's your perspective on this? I mean, you, you spend a lot of time, uh, you know, with employers, uh, of course working through some of these needs and their trend, you know, reducing friction employees, making the benefits, work harder for employers. Um, but maybe, maybe, you know, to that you could add the employee lens as well. And that's, you know, something that you touched on also Rob, like this just isn't about employers, it's about better healthcare. It's about reduced friction. It's about improved, um, outcomes. Like how, how are you seeing it from your seat, Paul?

Speaker 5: (10:17)
Yeah, thanks Chris burn. Good afternoon, everyone. So yeah, in my role, I, I have the opportunity to talk to a variety of employers, some very small, some medium size, some very large employers. And I, and I would say just kind of build on what Janet Rob was saying. Um, kind of from that employer lens, it really is around kind of how do we bend that cost curve? They're I think at a point of frustration of seeing those 6% annual increases on the impact to their bottom line or their, or their benefits spend. And I think every employer is unique. Some are very paternalistic where they've kind of absorbed those costs and they just wanna do that as part of their company culture. Some are very cost conscious, some are innovative or looking for solutions, but at the end of the day, what's first and foremost in their mind is how do I, uh, bend that trend?

Speaker 5: (11:05)
How do I reduce my, uh, employee costs? But that's coupled with some of the things that Janet and Rob talked about, which is kind of what's happening in the market, or what's happening kind of more at a macro lens, particularly around the ability to attract and retain employees, right? We're all I think kind of going through this great resignation here and benefits are a big component of that. So they're looking at how do I get the most outta, out of my benefits to retain the employees I have and track the ones that I really want to help me drive my organization. The other thing I think employer groups are looking for is, um, they want their employees to use their benefits. Appropriately employers spend a lot of money. It's usually the second, third on their balance sheet in regards to cost. And they spend a lot of money, bring a lot of solutions to the, to the table.

Speaker 5: (11:51)
They want their employees to engage and when they engage, they want them to use the right care in the right setting. And then as Rob mentioned, I think employers are looking at kind of the solutions that I bring forward for my employees. Does that encompass whole person care? Is they really direct to point solutions? Or is it managing my employees overall health and wellbeing. And particularly at this time behavioral, Health's a, a, a significant component of that. And so when I think about the employer needs, and I also kind of put a lens on the employee needs, I think they're pretty much aligned. I don't think they're very far off. I think the big difference is when you think about the employee and I'll even say I'm guilty of this, myself is typically the employees don't engage until there's an issue until there's a health issue until I need to use my benefits.

Speaker 5: (12:41)
Then all of a sudden I become very interested in what I, what has been offered to me. Um, so that's always a challenges to drive engagement, drive adoption, but at the end of the day, what that employee's looking for is similar to the employer. They want low cost. They want low out of pocket expenses. Most don't kind of budget for those unexpected medical expenses. So they want, um, their healthcare at minimal cost to them. They also want convenience. Everybody's very busy leads, very busy lies. We're all working very hard. They wanna be able to access the healthcare system conveniently and they want the security. They want the security to know that their benefits are there to protect them. So they have that security. And then also as I think about the employees and I kind of put, again, my, my own lens on this, I think more becoming comfortable using virtual care. I even, again, myself over the last couple of years, I'd say the vast majority of my care has been virtually. Um, and I think employees are becoming more comfortable not having to go to the, to the bricks and mortar, not having that inconvenience of doing that. So that's kind of how I see that kind of employer, employee lens Christopher.

Speaker 2: (13:54)
Got it. Thanks Paul. Mm-hmm  Hey, you, you guys have done a great job setting the, the table. Um, you know, what are the trends? What do employers care about how employees think about it, you know, attracting entertaining employees, reducing medical costs, reducing friction, um, some of the transgen that you've talked about with health and wellness, DEI, um, innovation that's happening out there. Um, I think that's a really rich perspective, um, that we should all keep in mind is, um, maybe we turn our attention a little bit more towards the mechanics of, uh, virtual care. Um, and how we think about, uh, you know, the specifics of some of the solutions that, um, are out there now. I think, you know, Rob, um, it was an eye raising, uh, eyebrow raising statistic. There was, there used to be a few. Now there's a few hundred. Um, so tell us a little bit more about that market. You know, it sounds like, uh, there's definitely some complexity there. What are the different types of virtual care? Um, how do we think about, you know, the solutions and

Speaker 4: (14:50)
What's available? Yeah, they're, they're really are Christopher. It's been, um, just for anecdotally, they, I think back to when the, for example went public and I think the industry is probably doing what more visits in a couple of weeks than they were doing in a given year or a handful of years back in, uh, you know, about five to 10 years ago, but it's just been obviously a really, really exciting evolution to see the awareness and the engagement begin to pick up. Uh, but to answer your question more directly, you know, the, the framework that I think about when employers sort of ask me where to start, you know, is my first interest point into virtual care, I'm trying to get better educated. We try to paint a picture for them that has a, a mental model where there's sort of two different dimensions. The first dimension is really like the way in which the care itself is delivered.

Speaker 4: (15:37)
I'll unpack that in a second, that's one spectrum sort of like lightest touch to most engaged. And then similarly, the other dimension is how was the care sort of offered? What's the benefit wrapper? What's the packaging? How is it served up, uh, to the individuals? So first on that spectrum of the care delivery, I think that you could put it in probably a three, if not four different buckets. And I'll, I'll start on the left side. And then I'll talk about that other axis here in a second. So, you know, the left most side, what I say is like the, the lightest touch easiest to implement is that that text based or messaging based, uh, approach, it solves problems for a large pop, large populations. It's quick, it's easy to access it's by definition, somewhat narrow in scope, just because of what you're able to address.

Speaker 4: (16:19)
And at certain points, lack of integration with the overall system, but as a really, you know, kind of quick hit low priced way to go ahead and deploy one virtual care offering for, for an employee base. The second step along that evolution I'd call, you know, the, the virtual only models. And this might be the way that some folks think about kind of a legacy telehealth telemedicine space, where yes, it goes beyond what tech space can handle because you've widened the aperture of, you know, the medium. So you're using video, you're using phone. You might be making some referrals here and there sending a medical record here and there. So there's some level of integration with the broader system, but it's still, as, you know, as I described a virtual only model, and we're seeing the emergence of a handful of those, but, you know, frankly, some players really pivoting out of that and recognizing they need to be more deeply integrated with the broader healthcare system, the sweet spot.

Speaker 4: (17:04)
And the one that, you know, I really believe in the one that we're focused on is, is this hybrid model. Again, back to that earlier point, that's the third stop along the evolution that I'm describing, one where the user, you know, aside from, you know, knowledge of where they're physically located, doesn't even really think about, am I having a virtual visit or am I having in an office visit, you know, the cliches and all those kinds of things, the comparisons to banking and otherwise have been drawn on our industry a thousand times. So I won't repeat that message, but it is that same evolution and really getting to, you know, a point where a consumer is not saying this is physical care, or this is virtual care. It's just the care that I need at a given time. So that hybrid model really feels like a sweet spot for us and is, and is the model that's probably most interesting to me.

Speaker 4: (17:45)
And then the last stop of course, is what I'd call sort of legacy, um, bricks and mortar providers who have historically delivered care inside the four walls of facility and are trying to pivot dimensions of their business model into how do they deliver virtual care to their patients, expand their patient populations and, and otherwise, um, the other access that I described, like I said is, you know, how is it packaged? How is it delivered? And, you know, for our audience, I would say, think of a spectrum that is, you know, there's the ancillary lightest touch can be deployed to an entire population approach, or there's a virtual first health plan all the way at the other end, the ancillary benefit being, uh, easier to deploy, of course, because it's, you know, agnostic to underlying carriers, it comes at a lower price. It doesn't have the same level of integration.

Speaker 4: (18:28)
And then if you push that to the other end of the spectrum, which would be a virtual first health plan is something that a consumer actually chooses at open enrollment. It's integrated with prior ath and prior cert and all of those things that need to happen within a complex health plan environment. And, you know, one is not necessarily right or wrong along any of these two different spectrums, but I'm just trying to paint a picture that maybe will frame the conversation today. Uh, so to put sort of a concluding point on that, as you, as you call out my observation of that, you know, we've gone from a few options to a few hundred, we really encourage prospective purchasers and our partners to think about where they wanna land on this matrix that I'm describing, because obviously, you know, every group is different and every group has different needs, but that's a, that's a good starting point I think is a mental model.

Speaker 2: (19:07)
Yeah, that's super helpful. Rob, one, one of the, one of the questions is actually coming through the Q and a, um, is about how some of these models, um, on the couple of dimensions that you've outlined, um, could potentially help broaden, uh, the types of solutions or conditions or interests that are being addressed. So I'll, I'll just read the question, you know, traditionally, um, they've been focused on conditions such as diabetes and muscular skeletal, uh, how is virtual care or will virtual care help broaden the employer's interest include other high cost conditions like cancer or, or others like that. So, you know, I guess that's for all, any of you, all three of you, how, uh, how do you think about that?

Speaker 4: (19:53)
I'll go first maybe, cause my comments precipitated question, I'll let you Paul, um, add on a couple things. I come back to what I said at the outset, right? Which is just the, the depth of what we're able to do clinically nowadays. Well, by definition, Chris, I'm understanding the question correctly, just expand what we're able to address, whether it's gathering data in the home, whether it's using AI and NLP, to understand where someone is along the acuity or where they are in the evolution of a given disease, just like what the information we can gather. Foundationally just makes it such that we can address a broader range of, of conditions and sort of build on that theme. The more we can put that in one single place for the consumer. So they don't have to think about, do I go here for that? And then there for this, it all just resides behind that one front door is gonna make things, um, you know, much, much easier for them.

Speaker 4: (20:39)
And then I guess my other comment is something that's been, you know, really critical to me and, and to tele we've been building out the primary care solution is, um, it, it cannot be agnostic to geography and where someone is located in such a unique way that didn't exist previously. We're really focused on making sure that the person who's in like the far long rural corner of somewhere in America has the same exact experience as somebody who's sitting in Los Angeles or New York, or what have you, the contributions that that has to help equity and the care that a person can now get, that they didn't previously have access to is just really, really meaningful. And something that we see is really exciting is the frontier of what primary care and virtual care can do in this context, Janet Paul I'll, I'll pass to you guys to see if you have anything to add.

Speaker 3: (21:20)
Yeah. Your last point, Rob was one that was going through my mind. I think the next wave that we'll see in virtual care will become this like highly specialized solutions and, you know, being able to, you know, fill in gaps and access. So something like providers that, you know, are, are sensitive to QIA a community needs those, you know, those providers don't exist everywhere, but through virtual care can be brought to everyone across the country. Um, so, you know, I think more and more we'll see those highly specialized, um, needs being addressed, virtual care just because of the lack of access. Otherwise just, you know, is pretty acute. In some cases,

Speaker 2: (21:59)
You know, mental health is another big one that, um, that we, we talked about before as we were, you know, comparing those and preparing for this, it's a question that's come up in the Q and a as well. Um, how do you think about virtual, um, capabilities expanding route to, to, to care for VIR for mental health as well?

Speaker 4: (22:17)
Well, the headline obviously, uh, um, I think you're directing that to me to start or otherwise others interrupt, um, somewhat to what I was saying with respect to primary care, any other provider types, obviously that's a place where we've got some of the most widespread shortages and especially in rural areas where you've got people, literally traveling hours previously to see a therapist and mental health provider or otherwise, but it's not actually just the access to the care at the time of need. It's the awareness of even arriving at that point to begin with. So putting an emphasis on screening for mental health, making it a part of an individual's journey to, you know, better manage their own health. As I was sort of alluding to the, the, you know, information we're able to gather now by, you know, driving engagement and the awareness with using new tools and technology.

Speaker 4: (23:00)
I mean, we've seen some really cool stuff of like NLP and AI in other words, or, you know, essentially diagnosing mental health needs fully remotely, um, the reach of those technologies and making it such that someone no longer has to, you know, drive to a psychiatrists office just to get necessarily a diagnosis for example, is, is really, really compelling. And the ways also in which these are being integrated with the broader suite of services. So if I find out from my virtual PCP as an example, that I, I do need a mental health visit, for example, and I can have that same visit from the comfort of my own home is just gonna broaden, you know, the ability of, of individuals who have that need to access that just dramatically, uh, easier than they could have previously.

Speaker 5: (23:38)
Yeah. And, and when I think about kind of the, the offering, particularly around the, the virtual first kind of health plan, it really the, the, one of the key benefits of it is, is kind of what Rob is mentioning. It's really that care coordination it's entering the healthcare system. So whether I have cancer, diabetes, mental health, oftentimes people are a little hesitant or concerned or have anxiety around that. You know, they don't have that doctor in the home to guide their care through these virtual, uh, first health plans. They have somebody to, to guide that holistic kind of view of the healthcare system have their information to guide what's personal to them to help them through that journey. And that is critical again, whether it's these chronic conditions, whether it's behavioral health, whether it's just getting them to the right pH physician, those that are high quality, low cost physicians. I think somebody being an advocate for that, that employee or for that patient, um, helps with that journey and helps with our health outcomes.

Speaker 2: (24:39)
Terrific. Now, you know, it occurs to me, all these solutions are great, but they matter not unless people actually adopt them. Right. And so, you know, this is not a new thing, but it's a, a newly growing thing at least as rapidly as it has been, you know, and the pandemic, uh, created some shocks for adoption, of course. Um, and maybe one would expect as the world returns to a little bit more normal that we'd see some decrease in usage, but, you know, Rob, from, from your chair on YouTube, maybe Paul, like, how do you think about employee adoption of these solutions? And then there's also, you know, look differently, older population that you're a little bit less digitally savvy or not, not so much, or how do you think about adoption for the different segments?

Speaker 4: (25:30)
Sure. I'll uh, go first, maybe Paul, then, then I'll pass it over to you. I've gotta actually sort of tie these two things together, very consumer comments there, uh, Vivi mental health. Um, but, uh, you know, Chris, we hit on, obviously one of the key themes that the silver lining of the past, uh, 18 months during COVID has really brought about enormous awareness engagement. Uh, I would even say, you know, consumer expectation that this be part of, of their care be part of a benefit offering in the future. Um, so what, you know, we really put an emphasis on is, um, you know, driving that top of mind awareness at a point of need, as Paul was suggesting, oftentimes the challenge with healthcare, someone doesn't think about it until they need it, but, um, by stitching things together in a single solution that same front door, uh, and driving, you know, many, many touchpoint with the consumer throughout the year, there is that top of mind awareness that that sort of comes with that surround sound feeling of, of engagement.

Speaker 4: (26:22)
We're doing that based on, you know, a number of different data points that we might have around an individual. So if they're a frequent flyer to the ed, if, if we know for example, they don't have a PCP from their claims data, as, as another example, there's different messaging that needs to be highly personalized. It's, it's not gonna be a blanket approach. Obviously that's gonna work for all. Um, just maybe two other quick comments. And, and one of these I'm gonna sort of, like I said, tie back to what Paul said there is that, that, you know, the benefit design is, is just so critical. We're all obviously talking about cost here, lowering it for the employer, but also passing on some of that saving to the end consumer. You know, we're seeing in, you know, consumer research, obviously that there's a great degree of interest in lower price plans and certainly a willingness to accept virtual in order to do that.

Speaker 4: (27:04)
But if I think about an example of mental health, if my PCP tells me, you know, Rob, you need to go see a therapist psychiatrist, or what have you oftentimes, ER, folks is just simply one. I can't find one that's available, but also my benefit design makes it such that's prohibitive for me to go and do that. Uh, so top of mind awareness is great, but if it's still structured in a way that that's prohibited for someone that's really challenging. So making the benefit design and making the vehicle in which it's delivered work for engagement is, is really a critical focus for us. And Paul, I know that's something you and I have talked about frequently, so I'll let you add on and see if you have any comments from there.

Speaker 5: (27:37)
Yeah. Thanks Rob. So thinking about engagement and getting employees to, to utilize those benefits, as, as we said, you know, that's, that's always a challenge, right? So to get people to be interested in their healthcare, um, throughout the year, not only when they need it, I think every employer is, is faced with those challenges. Um, and so really it's about how do you improve on that? How do you increase that engagement? So recently we had conversations with a large employer, um, that offers a, a solution and they were chatting with us to, and, and questioning why people weren't engaging. And we asked them, what was our communication strategy? How were you getting the word out to, to the employees to use this benefit? And that the answer was we put a flyer in their open enrollment packet once a year and hope that they drive that engagement.

Speaker 5: (28:26)
And so I think the employer groups, the HR departments, um, in partnership with your health plans or your point solutions really need to have kind of an, an active marketing communication plan to drive, drive that engagement. And it has to be multi-channel right. So we, we all rely on our, our cell phones, but when you look at the spectrum of employees at an employer group, some are comfortable with it. Some don't wanna engage with it, someone engage via email or mail and, and some wanted to kind of be pinged by their, their HR department, some don't. Um, so you gotta look at it kind of multi-channel and, and the last thing I would say to kind of drive that engagement is data. So data obviously is king, right? So looking at the data, looking at gaps in care, sending push notifications out to employees to, to drive that engagement will help. Um, I, again, I don't think it solves everything, but, um, having a strong communication plan to drive in employee engagement will help with the engagement will help with the outcomes, uh, Janet, anything to, to build on there.

Speaker 3: (29:30)
Yeah. I think, you know, um, Rob mentioned earlier that the idea of having a front door to care, or, you know, we talk about it that everyone needs a health home front door, like where's that one place to go. Um, and the more that, that is a clinician, I mean, the, the research will show that people are most likely to follow the advice of their, you know, primary care physician and care team versus employer or anyone else. So to the extent that you can, you know, sort of move that upstream to where care is being prescribed, you know, whether that's sort of a variety of strategies that sort of wrap around that front door of care, I think that's, that will be, um, more and more the future of how employers will work to engage their employee.

Speaker 2: (30:11)
So, so we're already kind of hitting on this topic. So I'll just ask that question, frankly, like if, if I'm a self-insured employer, um, you know, sitting in the participant group now, like how do I think about evaluating these solutions? You know, one that reduces cost of care. One that engages my employees, one that delivers better health outcomes. Like all that sounds great, but like, if I actually gotta go do that, like, how do I think about evaluating those, you know, Paul, Janet, what do you think?

Speaker 5: (30:36)
Sure. I'll start and Jenna, feel free to, to jump in. So I have had experience, uh, kind of managing a, a suite of point solutions in the past. And as Rob said, there's thousands of these out there. And, and I know a lot of 'em are calling the employer groups, trying to sell their wears, and it's hard for that employer to go, which ones add the most value, which ones are really gonna help me. And so, as an employer, the advice I would give to them is, you know, certainly look for the, to understand the value you're getting for what, what you're spending on that. Is it impacting the healthcare spend second? Is it improving the health and wellbeing of your employees, or is it causing confusion? You know, think about the overall member experience. Do I have to call one number for muscular skeletal and call another number for behavioral health and another one for diabetes?

Speaker 5: (31:25)
So it, is it really adding value and then last kind of what we hit on a few times, is it convenient? Can I do it on digitally? Can I get access to it right away? And then the last thing I would, I would advise employers is, is really around reporting. Can I get the data? Can I get reporting from these, these solutions that I can really evaluate to see if I'm getting the return on investment? Is it driving that engagement we talked about? Is it improving the health outcomes? So that's kind of how I would, uh, advise employers looking at a variety of solutions.

Speaker 3: (31:58)
I think that's a really great framework, Paul. I probably would just add a few things maybe front and at the end. So upfront would be really being very intentional about, you know, what problems you're trying to solve with the solutions. So what does your data say? You know, what are truly impactable , um, problems, and then are the solutions actually proven to, um, have an impact on the problem that you're trying to solve lot sub solutions out there saying they can do all kinds of things, not a very small subset who actually have proven results in doing it. So, you know, intentional focus on, on solutions to, you know, problems, finding solutions to problems that can be solved, um, in an impossible way. And then, you know, we've, you know, Rob mentioned like hundreds of vendors out there, and I think more and more for employers, they're working with multiple different vendors. So it's not just your relationship with each individual vendor, but how do they work together? Mm-hmm  um, are they sharing the data, uh, and willing to share data in a way that lets you accomplish your goals? Um, are they willing to enter into share performance guarantees around results because each of them sort of are hitting a piece of the, the problem. So really thinking about ecosystem holistically rather than each individual vendor and, and selecting vendors who are willing to participate that way,

Speaker 2: (33:12)
I love it. Um, I love that we're talking about data. I love that we're starting to talk about the benefits and the results. Um, so it's a, it's a great place to go. Like what are we seeing in terms of outcomes so far, you know, Rob on the individual side, like what kind of health outcomes, what can you point to with some of your data, Paul, Janet, from the employer perspective? What, what kind of cost savings are we seeing? There's a, a, a great question that came in of, you know, total healthcare spend that's out there right now. What percent of that do we think that we can really address, like, you know, brag a little bit, but also point towards the future? Cause I'm sure there's even more that we can do, but where, where are we today? What are we seeing? What are the results?

Speaker 4: (33:52)
Sure. I'll uh, Chris I'll, Christopher I'll take, um, sort of the first parts there and then, then chime in with the rest of the group. Um, Jen, I really like that you sort of pointed to like, what are some of the macro goals of an organization that they're trying to solve? Because if I go through like the highest, some of the highest order, you know, challenge that we're trying to solve, that's, you know, matching number of individuals who don't have a PCP relationship today, what's the effect that we're having on expanding access to prevention, wellness, and all the benefits that come with primary care. It's a bunch of dimensions and, and measures that come after that. But some really, you know, headline things that we're, we're looking at, cuz obviously that all bubbles up to the impact on quality costs to access that we've been, we've been talking about here.

Speaker 4: (34:31)
Um, but more specifically, so some of the things that, you know, we're watching closely measuring, you know, one of those, those headline numbers, as I said, is what percentage of the, the, the folks in our program are members are coming to us who don't have a PCP relationship. Haven't been to a PCP in the past two years, or, you know, maybe been a high flyer at the emergency department might be used in the urgent care as their physician in a, in a good case or, or frankly haven't had any interaction with the healthcare system whatsoever. So, you know, chronic disease is going undetected, mental health needs are going on met. So we're really closely watching both through, you know, member reported data as well as looking at, you know, claims and other information when available to, to, to see really how we're impacting populations, that don't have PCPs, um, a couple other things to watch, you know, really closely in ways to frankly, you know, evaluate the effectiveness of programs is, um, you know, speed to speed, to access.

Speaker 4: (35:20)
And not obviously just for like an urgent care need, but you know, we're all well aware of the pervasive problems with both primary and specialty care in the wait times just to frankly, become a new patient in a PCP practice. You know, we're truncating wait times down from what can be 30 days on a national average to, you know, guaranteeing new patient PCP availability in a matter of days, nevermind cost that dimension of just time to the visit is another barrier for individuals. So ensuring that the solution is not just virtualizing the problems that we have today, but actually bringing forward new solutions that advance and break down those barriers in a, in a meaningful way. And the results of that, you know, Christopher really, you know, excited to see that, you know, that's already, you know, playing out. Um, you know, for example, we're demonstrating, uh, early detection of chronic disease, about a quarter of diabetes, hypertension diagnoses that we're delivering our first time for the members that really shows obviously effective getting somebody in, who doesn't have a PCP for appropriate levels of prevention and screening and, uh, you know, that sort of all bubbles up to, uh, the really fantastic member satisfaction results that we're seeing from our consumers.

Speaker 4: (36:25)
I love reading the, you know, the anecdotes and the comments from the members who are suggesting, this is the way I wanna see the physician, the future. This is the best PCP relationship I've ever had. These are all different dimensions of access, quality and calls like we're talking about here and, you know, are, are very much in the early innings, but really excited to see the, you know, wide scale impact that, you know, the, the bringing for the benefits of, of primary care and whole person care are gonna have. And the models that we're we're talking about here.

Speaker 3: (36:50)
Yeah. I think some of the things you touched on Rob around, you know, sort of the impact on access on health outcomes, you know, all important things to measure. And then Christopher sounded like in your question, there was woven in there around cost, which, you know, I think often when we're looking at these solutions, we're trying to measure a very elusive measure, which is what didn't happen. So, you know, how do we know that, you know, cost that would've been there otherwise didn't happen is rare that it's actually lower than it was the year before. It's less than what trend might have been. And, um, we've done some really great, I would say very pioneering work around match cohort analysis to really compare like identical populations to each other. And did you know the solution then actually have a difference on the health outcomes on the per member per month cost?

Speaker 3: (37:37)
Um, really sort of more isolating, you know, and, and digging deep into, into the population to, to really understand those differences. And we have seen across different solutions that we've measured, um, you know, a mental health solution, a navigation solution that, you know, when done well, they are making it a difference across multiple of those, um, measures. But again, it gets back to my point earlier around, um, selecting partners, um, do they have the proven results and is the actua actual actuarily sound in terms of how they came up with those results? Um, and third party validated studies, those types of things are what really, what employers should be looking for when they're selecting partners.

Speaker 4: (38:21)
Oh, what would you add in terms of the, the benefits that employers are seeing?

Speaker 5: (38:25)
Well, I, I look at it from the lens of, and I certainly don't mean this to be a commercial, but we certain, uh, we announced the partnership yesterday with, uh, Teledoc around kind of a virtual first health plan, my virtual care, uh, my virtual care access. And just looking from that lens on, if, if we drive the engagement, drive the employees to, to receive their care, uh, virtually incentivized through the health plan, um, use using the, the benefits of that to get employees to, uh, when they would need to use bricks and mortar to those right physicians can lower cost, high quality physicians. We have seen when we've evaluated kind of this offering to some of our, our employer groups that the savings is significant. Again, there's different options you could do in plan design to drive that savings. But we've seen that savings go from as, as, as low as around 10% overall spend saving is the highest 30% it's going to vary employer by employer. But when you think about an employer's spend, even 10%, even 5% is significant. And again, it hits that bottom line, what they're trying to improve and improves their health outcomes. It's easy and it's convenient. So I kind of look at it from that lens of, of where I started with the employers frustrated with that 6% increase every year, move to this hybrid model of virtual primary care wrapped with national networks, with a comfort to go to bricks and mortar. This hybrid approach does impact spend.

Speaker 2: (39:59)
Yeah. And for, for the more progressive employers, maybe there's, you know, those among the participants who have, you know, been embracing some aspect of virtual care for, you know, at least months, maybe years and years now, like how would those more progressive employers think about a virtual first offering? You know, maybe not virtual only, but virtual first in this context, like where where's the innovation gonna gonna happen and like, how do they think about where the puck's going?

Speaker 3: (40:31)
I guess I can jump in on that one.  um, so there's been so much in the press even in the past month about virtual first. Um, but there's a lot of ways that that can play out. Um, I think so many of the, um, plans that are being introduced as virtual first really are, there's a virtual virtual primary care physician embedded as a network provider. And if you use that physician, you pay less, but it's not really a, you know, virtual primary care is the front door to care that we've been talking about that then guides the individual through, you know, the rest of their healthcare journey. Um, so, you know, when, when we're thinking about like, what's the ideal of a virtual first solution and the things when we talk, um, with these factors with employers that we work with gets them pretty excited.

Speaker 3: (41:20)
It is that, that really, that truly up front door to care, um, starting with virtual that then that primary care physician and care team is invested in helping that individual navigate the rest of their care. As, as Paul said, you know, using costly quality data to refer to best providers when in person care is needed, you know, taking care of their needs virtually, um, you know, having, you know, really investment in the longitudinal care of the individual that, you know, they're looking at proving improving health, health outcomes over time, um, having a care plan in place. And then, um, really importantly, having a different type of payment arrangement, you know, fee for service payment arrangement in this environment does not encourage all the types of things. I was just talking about the care coordination, the referral oversight, the longitudinal, you know, staying engaged with an individual, monitoring their data, keeping track of what's happening with them and reaching out when appropriate. So it really needs to be a shift away from, you know, a fee for service to more of a value based arrangement that, you know, reflects the additional investment and primary care that needs to be in place. So that type of model, but then also has, you know, um, responsibility as part of that for improving health outcomes and, and lower cost.

Speaker 2: (42:38)
And this follow might be for you Janet, or maybe it's for you, Paul, but, you know, as you think about, um, virtual care, what complications or maybe benefits probably get a little bit of both. Uh, do you get, when you begin to combine with traditional network design and then specifically, how do you think about reference based pricing combined with virtual care? You know, what, what idiosyncrasies arise from that combination?

Speaker 5: (43:08)
Do you wanna, do you wanna take a crack, Jen and I'll build on your thoughts there?

Speaker 3: (43:12)
Sure. So, you know, I think there's different ways to think about virtual care. One is, you know, I was talking about a model where primary care is sort of embedded in the network, but each time somebody needs care and they can decide, am I going to have a virtual primary care visit? Am I going to go in person? Am I gonna self refer to a specialist? So that's a different model, but in that model, it's sort of available to everyone, you know, who's in that plan. The other model is it's a plan that's offered at annual enrollment and employees choose to enroll in it. And I think as we've talked about that with employers, um, a lot of excitement about, you know, a, a really differentiated approach that can be an attraction and retention tool, and also, um, a, a way to offer a, a cost effective alternative to high deductible plans.

Speaker 3: (43:58)
But also the worry that just like we saw when we introduced high deductible plans 20 years ago, it was the young, healthy people who enrolled. And, you know, if that's the case, then do we sort of accomplish our, our broader goals with it. So I think, you know, really taking a close look at the population population, you know, demographics, isn't a fit across, you know, a variety of, um, individuals and having a plan design, that's going to encourage a variety of people to enroll, you know, those with chronic conditions that they, they see that it's cost effective for them will be more, you know, likely to enroll in it. Um, and Rob, I think from some of the research, you've, you've all done. You've seen the pretty broad cross section of consumer interest in that type of plans. So not just the young healthy that, you know, we might anticipate would be the first to enroll.

Speaker 5: (44:43)
Yeah.

Speaker 4: (44:45)
Yeah. That's exactly what we've seen Janet. Um, and it comes back to what's it gonna cost me, how am I gonna be able to access the providers that I need? And does it create any disruption in the existing relationships that I have and, you know, in the solution that we've, um, you know, would trust mark on the poll is alluding to there. This kinda gets back to that notion of, of, of packaging, both in solving the problem for the employer of only having to Mander a so source single point, uh, vendor versus, you know, many others in a vendor, frankly, that solves a lot of those problems for the employer by stitching all these things together in a coordinated way and solves that same problem for the user as well. Cuz to Paul's example, they don't have to wonder what number do I call for MSK?

Speaker 4: (45:24)
What number do I call for mental health? How do I get a PCP? I just know that I have a relationship with this provider and with this care team and they coordinate the care on my behalf. And, and as it was alluded to previously, we believe the downstream savings from that. And frankly the, you know, the harder to quantify, but you know, the impact on, you know, the investment of time and so forth, the employer makes it gonna be significant as well because it's gonna happen in such, in a such, you know, in a fashion that's dramatically more coordinated than before.

Speaker 5: (45:49)
And so Christopher kind of back to your question on kind the, the, the impact of primary care, uh, on kind of the, the networks and maybe even the evolution to, um, reference based pricing. The way I think about that is you, traditionally employers have been a little conservative in, in wanting to offer some of these solutions because they're, they're concerned about the impact to their employees. They're concerned about the noise at some of these things, the, the risk of doing this, there is comfort in the way we do things today with a traditional PPO and, and, you know, high copays and deductibles. There's a little bit of comfort in there. Um, what we're starting to see is employers wanting to start taking some more risks again, to impact that cost curve. So I think this hybrid approach that we're talking about where the primary care, the care coordination is virtually wrapped with, uh, some of your traditional PPOs.

Speaker 5: (46:40)
So the, my virtual care access has two national partners there. So if an employee wants to go bricks and mortar wants to kind of take their journey on them themselves, they have that security of, of doing so I do see kind of employers start heading, trending more in that direction of forcing employees to go more virtual first, forcing a little bit more of the, get your care guided through a, a, a physician or a advocate to, to help you with that journey. The leap to, to reference based pricing, I think could be potentially an another avenue of this. Again, I think it's, there, it's a risk reward aspect of it. The reference based pricing organizations have become more adept at at ensuring that that noise and that confusion and that potential, um, conflict can be avoided. So I do see it kind of as an evolution to, to get to that journey and come away from your standard breaks, mortar, traditional PPO networks.

Speaker 2: (47:41)
Fantastic. Thanks Paul. Thanks Rob. Thanks Janet. Um, maybe one last topic and then there's, um, uh, a handful of other questions that we might just address here at the end from the participants. Um, but the last question, this is for everyone, you know, in, in order, however you want to jump in, but you know, as you think three to five years out, um, what would you expect to see in terms of adoption and impact from virtual care? You know, what does the world look like five years from now?

Speaker 5: (48:13)
Yeah, I I'll, if you don't mind, I'll, I'll start here. I, I think certainly COVID has pushed everybody to more of a comfort level with you. You, uh, receiving their care virtually whether it's on their phone or their laptop. Um, I do see a world where that is just the norm. That's where you get your care. Um, will there always be a reason to go to the hospital or get in person care? Yes, but it'll be more coordinated through your phone and through, um, virtually, um, just as, as an example, as having a conversation with, with somebody recently, and they were talking about the care that they receive and how they receive their care, they have some heart conditions and they have several monitors that monitor their, their, the rhythm of their heart and some of their, the issues that they're dealing with, they have a cardiologist that they see maybe once a year in person, but the vast majority of their care is provided by Mayo clinic in Minnesota, the, the physicians are monitoring the wearables, monitoring their care, and this person is never step foot in Mayo clinic. So I can see a world where that's the type of care you're getting. Again, it's not, let me just look in the phone book or look in the provider directory and pick out a provider it's more coordinated in getting the patients to, again, those, those best high quality providers.

Speaker 4: (49:40)
Um, I'll add sort of Paul, a couple things that you've said there. And then Christopher, maybe answer your question sort of where we see things in, in 3, 5, 10 years, um, back there, Paul, with reference, just in terms of how people are thinking about, you know, where do I get my care and acceptance of, of virtual care. I would even push that further to say that it's not just the acceptance, that virtual care will be part of the model, but in that consumer research that Janet alluded to, and what we're seeing on the horizon is that consumers not just accept it, but they actually expect it. So, um, as we make predictions for the future, you know, I really envision a world where I sort of touched on this earlier, where you're no longer calling it. Virtual care is just a way in which I receive care.

Speaker 4: (50:21)
Mm-hmm , I think the same thing will be true about benefits. We won't need the moniker of virtual first health plan. It will just be the nature of a health plan product and a consumer expects. Yeah, this is where I go first. This is the, the front door that my carrier has built for me. And not only do I get the benefit of a lower price and better economics that come with that, but as a consumer and the world that we live in today with all things being on demand and the experience that we've had through COVID with, with virtual care and so forth, it will be the expectation. So I think that there is a win-win there where, you know, so many of those benefits accrued to, you know, both the purchaser to the user and to the overall system. So I'm really excited to see, you know, as, as much as we're driving the virtual care train here, I'm, I'm really excited to see, you know, um, that the elimination of some of those distinctions and, and living world, like I said, where it it's, it's just your health plan. It's just the care that you're receiving, because there has become such a seamless interaction between the two that the distinctions is no longer necessary.

Speaker 2: (51:14)
Yeah. Business as usual. What would you add?

Speaker 3: (51:17)
Yeah, two, two, maybe two other concepts I would add into all of it. And, um, one first around technology and second around reimbursement. Um, so, you know, Ron, when you were talking very early on about how you view sort of the spectrum of virtual care, start starting with text all the way through brick and mortar, I would actually add a stop to the left of text, which is just pure technology. And so even with text, you're interacting with a clinician, but there's a step even before that, that I think is growing more and more where technology can replace the need for a clinician or at least vastly supplement it and extend their, their reach. Um, and then that has the ability to, you know, help to, to lower cost and engage people in a different way. Um, but then that, that points us to the reimbursement, because for, for all of the things that we're talking about today, to really be able to transform how care is delivered in the us, which there is just incredible potential for it, the reimbursement system has to change.

Speaker 3: (52:17)
Um, we talked with the health system recently. Who's actually pretty much at the forefront of virtual care, but still says, you know, there's a lot we don't do because it's not worth the investment for us to do it because we don't get paid for it. You know, we get paid fee for service for, for the things that we do. And so to the extent that it helps us reduce the cost of delivering that service, we'll invest in it. But if it, you know, extends, you know, care helps patients in between visits, that type of thing, you know, right now the reimbursement doesn't support that. So sort of back to what we were talking about earlier to me, the tipping point that will really change the trajectory and something that employers should be pushing for with their health plans is to, to, to move to value-based reimbursement, encourage, you know, embracing, um, all of those virtual care technologies and paying for it and not paying for virtual care at 80, 80 cents on the dollar. Um, but you know, really thinking about, you know, the, the full power that it can bring and what's the value of that. And let's reimburse it that way.

Speaker 2: (53:18)
Wonderful. Thanks guys. Well, why don't we spend, um, maybe just a couple minutes on, uh, two or three quick hit questions, uh, that we've gotten, then we'll wrap this up. So Rob, maybe this first one is for you, which is where are we on trusted technology capabilities for home provision of vitals, wearables, you know, blood pressure, heart rate, oxygen level, and also visual tools for examination. How does that plan,

Speaker 4: (53:47)
Uh, I Janet's comments, there were perfect segue into this and we can have a whole discussion there, again, sort of using that same notion of different spectrum of, of options. Um, you know, we are, we're gonna begin to distill this into, you know, five, 10 seconds such a broad universe. Um, you know, I think it depends heavily first on, are you sending a device physical device into the home? Are you still relying on something like AI and LPO? Because I was alluding to it previously, obviously the device is being sent in the home, the pulse socks, the blood pressure monitor, like these are tried and true tests to improve by the FDA, all that kind of good stuff. The improvements that obviously we're making there, that they are cellularly connected. There's no worrying about syncing Bluetooth or any of that kind of stuff. The, the member's data is flowing through such as we're getting billions of data points a year.

Speaker 4: (54:28)
Those are, are obviously wholly reliable. We're seeing improvements in, in those on a, you know, a daily basis, um, as it relates to, you know, measuring pulses or, or blood pressure, any of those kinds of things, uh, remotely an enormous amount of, of, of progress and enormous amount of promise being made right now, but still very much, you know, in the early innings of those, but really excited to see those continue to unfold and be rolled out because that will only further, you know, broad the scope of what we're able to address, but also be able to obviously deliver things that much more efficiently in a, in a, you know, in a lower cost fashion to the end consumers.

Speaker 2: (55:00)
Terrific. Um, Paul, this one, I don't know if that qualifies as a quick hit, but, um, the question is, are insurance providers that are backend systems ready for innovation and service delivery coming down the road? How do you think about answering that one?

Speaker 5: (55:21)
You were breaking up, you were breaking up a little bit there. Christopher. I think I got the majority of it are the insurance companies backend systems ready to, to take on innovation. Yeah. Um, I would say they have to be right. I think, I don't think there's an option. As we said that the market is moving this direction. The employers group want innovation, they want solutions and they want it integrated. They, you know, to the example before, around kind of whole person care and looking at different point solutions, how do these all work together? How do they interact together? How do you take the data from all these solutions and do something with it? Is it all integrated? So I think they, they need to evolve there. Now, again, this will be a, a promotion for using a third party administrator, like a trust mark, where the one value of TPAs is flexibility. Our systems are flexible, the plug and play with different, um, organizations and, and kind of bring that data to the forefront. And so, um, that's, that's the value of the, of the flexibility, but I do see, um, health insurance organizations having to adapt to be able to, to, to be ready for this innovation.

Speaker 2: (56:32)
I think it's true. And I think, you know, we've said a couple times, but it is all about the data, right. That drives the insights that drives the value. Yeah. Well, let's wrap it up there. Janet Paul, Rob, thanks so much for your insights in the conversation. Um, I found it really insightful and interesting, and I'm sure our participants did this well, everyone for joining bye.