A study comparing major insurance company preventive care offerings to competing offerings. Health insurance premium costs have increased an average of 31% over the past five years. This significant price increase has prompted companies to develop a range of new care delivery models, focused on reducing the visit costs. To illustrate this point, this analysis will compare an urgent care offering, from a well-known insurance provider, meant to reduce the cost of patients’ critical care visits to the emergency room, and more innovative models that are exclusively focused on genuine preventative care. For this story, we will refer to this unnamed provider, “the provider.”
Misaligned Incentives
The provider’s take on preventing emergency room visits is through their urgent care brand, which operates about 360 clinics, across 24 states. The company’s ownership of clinics presents an inherent conflict of interest. The organization operates urgent care facilities that financially benefit from patient visits, creating a fundamental misalignment between critical care events that should be prevented and revenue generation for the company.
Additionally, only 30% of the provider’s urgent care facilities are advanced urgent cares. Advanced urgent care facilities are necessary to prevent critical care events from ending up in the emergency room.
Level One Telehealth
Traditional telehealth services, such as those provided through Teladoc and similar virtual providers, as a part of most mainstream insurance plans, typically have a lower standard of care than is required to prevent emergency room visits. This is because:
- The telehealth provider requires an appointment to speak with patients.
- The telehealth practice staff are mostly primary care physicians, who are not experienced enough in critical care to prevent emergency room visits.
Level Two Telehealth
In contrast to level one telehealth, level two can prevent up to 43% of emergency room visits by:
- Providing patients with immediate, 24/7 access to an experienced medical provider.
- Providers who focus on critical care expertise.
- Sophisticated triage capabilities
Evidence-Based Prevention Strategies
Research substantiates the effectiveness of specialized virtual care:
- Reduced company and patient spending on healthcare.
- Reduced critical care events, and complications, originating from those events.
- Higher patient satisfaction with their healthcare coverage.
Financial and Systemic Implications
The current healthcare model incentivizes facility-based care whereas innovative, virtual platforms prioritize preventive interventions to reduce facility-based care. This shift will continue as more individuals and companies seek to lower the cost of care while keeping positive health outcomes elevated.
Conclusion
Virtual care platforms represent an important innovation in preventive medicine offering a more efficient, cost-effective and patient-centric approach to medical intervention. As healthcare continues to transform, platforms that combine technological innovation with deep medical expertise will likely define the future of preventive care delivery. Scott Patterson is an entrepreneur, investor, professor, and professional speaker. He has spent over two decades in organizational leadership roles strategizing and developing enterprise security programs for organizations in health care, financial services, education, insurance and the Armed Forces. With that, he is also an instructor for the Federal Bureau of Investigation, New York University and NBC.
Contributed by Scott Patterson, Chief Executive Officer, Apex Investment Group
Patterson is an entrepreneur, investor, professor, and professional speaker. He has spent over two decades in organizational leadership roles strategizing and developing enterprise security programs for organizations in health care, financial services, education, insurance and the Armed Forces. With that, he is also an instructor for the Federal Bureau of Investigation, New York University and NBC.
