As health plans continue to advance their strategies in 2024 and beyond, virtual care and AI have the ability to help reach members in new and more personalized ways and address some of the most pressing challenges to affordable and effective care.
Recently, experts from Teladoc Health and Blue Cross Blue Shield of Michigan (BCBSM) participated in a session at AHIP’s 2024 Medicare, Medicaid, Duals & Commercial Markets Forum to discuss how these technologies can address access to care and member engagement, and how both are helping tackle one of the biggest chronic care revolutions of this decade: GLP-1 medications for weight loss.
More than $730 million in healthcare costs could be reduced through better access to primary care physicians (PCPs). However, one in three people in the U.S. does not have access to a PCP.
A virtual care front door can boost equitable access to care and encourage members to be active in their health simply by reducing wait times to see a PCP. As Chelsea Moore, Strategy Manager for Digital Health at BCBSM, explained, “There is an average 30-day wait time for people who have a relationship with their PCP; it’s much longer—possibly six months—for people who are seeking to establish a new PCP relationship.”
Conversely, with virtual primary care from Teladoc Health, health plans can connect members with a PCP within five days or less of their request.
Reduced wait times mean more people can connect with a PCP, leading to an improvement in preventive care and important health screenings, such as colonoscopies and mammograms.
Additionally, a virtual front door to care means access to a broader network of providers, which is especially important for people living in a care desert. Teladoc Health and BCBSM are also using virtual care to improve the mental health care gap through improved access, including 150+ additional mental health providers through Teladoc Health.
BCBSM has also been working with Teladoc Health since 2019 to help members improve their clinical markers (e.g., blood pressure, HbA1c, weight loss) when they have a cardiometabolic disease such as obesity, diabetes or hypertension. One key factor in this effort is keeping members engaged in their chronic care program.
As Alex Owens, MD, Clinical Product Lead at Teladoc Health, explained during the session, the collaboration aims to meet patients where they are, which can mean the right time and place, or in the language they are most comfortable speaking. Moore explained that BCBSM leverages AI to understand when certain types of outreach have the best chance of resonating with people.
Within the program, Teladoc Health leverages information from members’ devices, app use and care teams and feeds them into predictive data models to drive better health plan decision-making about which members to contact, what to say and when.
For these efforts, language and cultural competency are key, along with knowing the type of provider suitable for a member’s needs and their preferences about when and how to meet with that provider.
“We’re finding that when we personalize our outreach and the type of care experience with our members, we’re seeing much better engagement rates and outcomes,” said Nabomita Dutta, SVP of Commercial Strategy and Partnerships at Teladoc Health. In one pilot program, Teladoc Health realized four times greater open rate of member communications when leveraging generative AI to determine who should receive specific types of outreach and in which modality.
In addition to improving engagement, AI helped BCBSM reach the 50% of its members who did not see a primary care physician in 2023 in an effort to encourage them to make that important preventive care appointment.
In addition to being a pioneer in virtual care and AI, BCBSM is also leading the way on a whole-person approach to weight management.
Partnering with Teladoc Health, BCBSM is delivering an integrated weight and obesity management solution that helps provide access to prescription obesity therapies while also ensuring members have the support for successful weight management with or without medication.
No single treatment modality works for everyone, which is why Teladoc Health and BCBSM offer members holistic support including step therapy, access to obesity-trained coaches and registered dietitians for medical nutrition therapy, digital mental health and educational resources on anti-obesity medications—all supported by a multi-disciplinary care team. The integration between Teladoc Health, BCBSM and the pharmacy benefit manager allows for flexible configuration to ensure the program fulfills their clinical benefit strategies.
As more members struggle with obesity as a chronic disease, “investing in additional support for GLP-1s will help improve outcomes, help members eventually come off of these medications and maintain their weight loss,” Moore said. "In turn, our programs help to curb the need for costly care down the road.”
Health plans that embrace AI and virtual care will stay at the forefront of healthcare trends and deliver superior care by making care more equitable, accessible and affordable.
By leveraging these technologies, health plans will not only exceed the expectations of their members, but also set a new standard of care for the healthcare industry.
