Virtual-first care has arrived – here's how employers can make the most of it

The key to success? Virtual-first primary care physicians

A nationwide, real-time experiment happened during the COVID-19 pandemic: Virtual care went mainstream.

First, the pandemic spurred Congress to loosen telemedicine restrictions for Medicare and Medicaid. States and private payers quickly followed suit. In the first three months of the pandemic, telemedicine visits increased 766%, to 23.6% of all medical visits.¹

“All of a sudden, doctors were empowered to deliver more care virtually,” said Dr. Nina Birnbaum, a practicing physician and medical director of Innovation Acceleration at Blue Shield of California. “And people were completely ready to receive it.”

Now, according to Dr. Birnbaum, it’s time for patients, as well as employers, to see virtual care as—well, just care. Starting with primary care.

“It’s time to dig in and really figure out what we can do with virtual care,” said Dr. Birnbaum. “Think an annual checkup can't be done virtually? A lot of what happens in an annual checkup doesn't require laying hands on a person. It's much more about having meaningful conversations with our patients about potential and existing health issues and making sure that we’re coordinating needed preventive services.”

Centering telemedicine around virtual primary care can address critical issues of convenience, equity, and affordability that in-person care sometimes can’t.

Primary care matters

Having a relationship with a primary care provider (PCP) is better for your health. According to Accolade, a virtual advanced primary care provider, 60% of their patients with a regular PCP are able to avoid ER or urgent care visits.²

“Most of what patients need for their health can be obtained in primary care, and they should always start there,” said Dr. Birnbaum. “Primary care doctors aren’t gatekeepers to the larger healthcare system, they’re co-pilots. This is true whether the care is delivered virtually or in-person.”

  • In addition, access to primary care isn’t just about catching health issues earlier and improving people’s overall quality of life; it can generate significant cost savings:

    Individuals who use a PCP have an average of 27% lower healthcare costs.³

    In short, primary care means better health for patients, at less cost to them and to the system overall.

    So why is it that 26% of all U.S. adults (and 45% of adults under age 30) don’t have a PCP?

Barriers to PCP adoption

There are a number of barriers to PCP adoption. Primary among them? The wait time to see a provider, and a lack of diversity among PCPs.

Today, the average wait time to get an appointment with a new physician is 26 days. And that’s in larger U.S. cities. For people in rural areas, the wait is even longer.⁵

These wait times are occurring to a workforce now made up primarily of Millennials and Gen Z, digital natives accustomed to on-demand ease and convenience. Primary care simply doesn’t meet their expectations.⁶

No wonder top reasons cited for not having a PCP include “It’s too hard to get an appointment” and “I can’t find one close enough to me.”⁷

Millennials and Gen Z are also the most racially and ethnically diverse generations to date in the United States. That’s why diverse provider options matter for people of color, women, the LGBTQ+ community, non-native English speakers, and others.

49% of Black and 50% of Latinx Californians reported difficulty finding a doctor with a shared background or experience.⁸ In one recent large study, seven in ten Black Americans said they believe discrimination in health care happens somewhat often, and Black adults are less likely to say they trust doctors and the healthcare system to do right by their communities.⁹

When patients receive care from doctors who share their background or experiences, the health benefits can be significant. A recent study in Oakland, California, found that African American men were much more likely to select all preventive services available, particularly invasive ones, when they met with an African American provider. The study suggests that having a provider of the same background could reduce the black-white male gap in cardiovascular mortality by 19%.¹⁰

How can virtual primary care help?

Virtual primary care: The time is now

More healthcare stakeholders are now looking at how virtual-first primary care might be an opportunity for a reset of sorts. While the pandemic created an overnight demand for virtual care, other factors were reaching a tipping point at the same time:

  • Electronic health records and other digital services became ubiquitous and accessible to patients

    Both doctors and patients experienced virtual visits as quality health care

    Millennials and Gen Z employees became the largest part of the U.S. workforce—and they expect virtual-first care

    • 44%

      of Gen Z and Millennials said they might switch providers if virtual care isn’t offered going forward¹¹

“Digital services have changed how we connect to the world and how we manage daily life,” said Dr. Birnbaum. “We bank online. We get our music online. We’re willing to meet our life partners online. Making virtual care more ubiquitous and accessible is the right thing to do. It works for people. It’s what they want.”

Centering virtual care around the PCP

The opportunity now, Dr. Birnbaum believes, is to turn fragmented telehealth encounters into ongoing, team-based, virtual-first care, led by a virtual PCP. An ongoing relationship with a chosen PCP as “co-pilot” helps each member navigate the healthcare system to achieve their best health. When that virtual PCP leads a team that includes mental health providers, specialists, and health coaches, virtual health care can be even more effective.

“Let’s say your virtual PCP sends you a colon cancer screening kit,” said Dr. Birnbaum. “Well, three weeks later, the health coach can follow up and say, ‘I noticed you haven’t turned in your kit yet. What can we do to help?’ Sometimes what is stopping that person is just remembering, but if the hesitation goes deeper and there is uncertainty about the value of the test or fear about the result, the health coach can gather the team around that member to help.”

Mental health is another area in which a trusted virtual PCP can help. The PCP can proactively screen for depression, anxiety, and other issues as part of an intake meeting or annual check-up, and then provide recommendations for a mental healthcare provider that best matches that member’s unique needs.

“With a PCP-centric approach, care feels coherent to the person experiencing it,” said Dr. Birnbaum. “They don’t feel like, ‘I’m on my own at a time when I especially need help.’”

Access for digital natives, remote workers, and healthcare deserts

Dr. Birnbaum sees virtual-first care as an opportunity to build in access, equity, and quality measures from the start. That can mean delivering care to previously underserved people, whether in rural communities or in urban areas considered healthcare deserts. It can also mean more accessible care for working parents, digital nomads, night shift workers, and others. Without the need to leave work or arrange childcare, people are more likely to get the care they need sooner.

  • “Virtual care shifts the frontline of care from the clinic to where a person is,” said Dr. Shantanu Nundy, chief medical officer of Accolade. Virtual primary care can also address issues of health equity, making it easier to match a more diverse patient base with providers who meet their needs and expectations.

    The quality is there, too. While we still have much to learn about virtual care, a study published on JAMA Network Open found that virtual care led to better or equal performance on 13 of 16 quality-of-care measures.¹²

    Those findings are confirmed by an Epic Research study showing that, of over 18 million virtual primary care appointments, 60% required no in-person follow up (and most often, follow-ups were pediatrics appointments).¹³

    Access, connection, quality of care—all of these mean better outcomes for patients and better value for everyone.

How employers can help “reset” to virtual-first care

While virtual care is still in its infancy, Dr. Birnbaum is eager to see where it can go. “If we package virtual-first care into a value-based framework, we can deliver the right care to the right person at the right time, whether it’s virtual or in person,” said Dr. Birnbaum.

  • Employers will play a big role in facilitating this integration. In fact, they already are.

    Employers ready to offer virtual-first health care to their employees should start by looking for a comprehensive, virtual-first health plan that includes primary, urgent, behavioral health, and specialty care. Virtual-first plans should always include access to in-person care when preferred or when necessary, so people can choose the type of care that best suits their needs.

    • 84%

      of employers believe integrating virtual and in-person care is necessary¹⁴

Then, communicate the benefits of virtual care to employees, at enrollment time and beyond.

Younger employees may lead the adoption of virtual care; others are sure to follow as they see the benefits of having their own virtual PCP leading a team of virtual caregivers, including mental health providers, who are available 24/7.

What is Blue Shield doing?

Blue Shield is introducing virtual-first care in a new plan called Virtual Blue, powered by AccoladeCare. The plan emphasizes value-based virtual care, in which providers are rewarded for better patient health outcomes, rather than paid on a fee-for-service basis. AccoladeCare’s virtual PCPs are empowered to deliver the right care at the right time to each member of the population they’re responsible for—not just reactively, but proactively. And of course, in-person care is always available for those who prefer it or when in-person visits are necessary.

With Virtual Blue, patients pay $0 for all AccoladeCare virtual visits, including behavioral health and specialist visits. That’s tremendously motivating for employees to get care when it’s needed, from a provider and team they connect with—without delaying care due to scheduling restrictions, time lost at work, or cost.

In addition to addressing preventive physical care, most virtual primary care appointments include a mental health screening for anxiety and depression. That means employees can get a recommendation for a mental healthcare provider from a PCP who knows what matters to them.

Accessibility, affordability, and a sense of connection: these factors all contribute to early intervention, consistency of care, and savings for employees and employers alike.

And employers now have the power to lead the way.

  1. Shaver, MD.: “The State of Telehealth Before and After the COVID-19 Pandemic, Prim Care. 2022 Dec; 49⁴: 517–530. Published online 2022 Apr 25. doi: 10.1016/j.pop.2022.04.002
  2. “The path to a healthy, productive workforce is virtual,” Accolade, 2021.
  3. Gao, Jian et al: “The Effect of Primary Care Visits on Total Patient Care Cost: Evidence From the Veterans Health Administration”; J Prim Care Community Health. 2022 Jan-Dec; 13: 21501319221141792.
  4. KFF Health Tracking Poll. KKF, July 17-22,2018. Accessed July 26, 2023.
  5. AMN Healthcare Center for Research: 2022 Survey of Physician Appointment Wait Times and Medicare and Medicaid Acceptance Rates, September 12, 2022; Accessed September 7, 2023.
  6. Boodman, Sandra G., KFF Health News: “Spurred By Convenience, Millennials Often Spurn The ‘Family Doctor’ Model”; October 9, 2018.
  7. Klein & Partners + Core Health, “2022 National Healthcare Consumer Study”;
  8. Caterson et al., “The 2022 CHCF California Health Policy Survey”, January 2022, chrome-extension://efaidnbmnnnibpcajpcglclefindmkaj/ or just
  9. Hamel, Liz et al; “KFF/The Undefeated Survey on Race and Health,” October 13, 2020. Accessed September 7, 2023.
  10. Avakame, Elorm et al; “Antiracism in Academic Medicine: Fixing the Leak in the Pipeline of Black Physicians,” May 4, 2021. Accessed September 7, 2023.
  11. Hsu, Joyce. “Personalized Digital Health Beyond the Pandemic,” July-August 2022; Accessed September 7, 2023.
  12. Baughman DJ, Jabbarpour Y, Westfall JM, et al. Comparison of Quality Performance Measures for Patients Receiving In-Person vs Telemedicine Primary Care in a Large Integrated Health System. JAMA Netw Open. 2022;5⁹:e2233267. doi:10.1001/jamanetworkopen.2022.33267 Accessed May 3, 2024:\
  13. Gerhart J, Piff A, Bartelt K, Barkley E. Most Primary Care Telehealth Visits Unlikely to Need In-Person Follow-Up. Epic Research. Accessed: May 3, 2023.
  14. Business Group on Health. 2023 Large Employers’ Health Care Strategy and Plan Design Survey. August 2022. Available at: resources/2023-large-employers-health-care-strategy-survey-intro