This is the first in a series of blogs we’re doing on virtual-first health plans. In this post, we introduce the plan model and their benefits to health insurers.

In the evolving healthcare landscape, the virtual first health plan (VFHP) has become a promising strategy to transform business operations, improve margins, and fuel growth for payers while raising the standard of care quality for members.  

One of the biggest challenges in healthcare today is increasing care costs. Payers and members spend $47 billion annually because of avoidable emergency room visits, and average annual health insurance premiums increased 7% in 2023. Despite costs, the insured share of the population reached a historic high of 92% in 2022 as private health insurance membership increased, and this illustrates a significant opportunity for insurers to grow membership and remain competitive.  

By successfully implementing VFHPs, payers can reduce unnecessary hospital visits and improve member and population health outcomes, resulting in measurable financial savings and a surge in membership growth.  

Here are four ways a successful rollout of a VFHP can boost financial performance and catalyze growth benefits:

1. Increase member access to care

Leveraging virtual primary care, online referred services and specialists and digital care programs can increase the percentage of your member population who has access to primary care, behavioral health and specialty appointments. This proactive approach gets members in, diagnosed and treated earlier, improving outcomes and reducing care costs.

2. Improve member engagement and satisfaction

By actively involving members in their care journey and creating a seamless experience, VFHPs can promote better adherence to treatment plans. Care that’s easy to navigate encourages members to follow through with appointments, screenings and treatments, keeping them well and improving overall health outcomes.

Also, hosting point solutions on a single platform with one digital front door makes access easy and creates better member satisfaction and loyalty, ensuring a solid member base, reducing turnover rates, and providing long-term cost savings for payers.

3. Enhance member relationships

One key aspect of the VFHP is its ability to streamline primary care, follow-up support, specialty care and behavioral health referrals all in one place. By prioritizing long-term relationships between members and their providers or care teams, VFHPs can lead to early interventions and better health outcomes for members, reducing the need for expensive procedures or hospitalizations.

4. Leverage data analytics and performance improvement 

Successful VFHP implementation involves using data to track key performance metrics, identify areas for improvement, and monitor organizational and member outcomes. Analyzing the data helps payers use their solution and staffing resources more appropriately and effectively. This approach not only improves care quality but also identifies opportunities for cost savings through targeted interventions and care optimization.

The successful implementation of virtual-first health plans holds the potential for payers to achieve financial savings and improve experiences and care quality for members. Embracing the principles of VFHPs is a strategic opportunity to drive meaningful change in healthcare delivery, financial sustainability, and organizational growth. 

To learn more about how a VFHP strategy can drive organizational success, read our full eBook and read our other posts in this series here.