Virtual care is becoming new benefit category on Jan. 1

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Group Health’s virtual-care services have been popular with members for many years: We introduced secure messaging via MyGroupHealth in 2000, followed by phone visits, and finally by our online diagnosis and treatment tool that’s currently known as CareNow. In 2017, we plan to expand our virtual capabilities to include a video component.

We’ve always known that virtual care is aVirtual care at Group Health great way to make health care more convenient for our members while significantly reducing health care costs. But up until now we haven’t had the ability to code and track our virtual care, and our contracted providers haven’t been able to bill for the virtual services they provide.

That’s changing soon. Effective Jan. 1, 2017, virtual care will become a new benefit category at Group Health. We’ll begin coding virtual services and tracking utilization, and in-network contracted providers will be able to get reimbursed for their virtual-care services.

The change applies to our individual and family, small group, large group, PEBB, and FEHB plans, and also to self-funded clients. It includes virtual care provided to in-network patients who receive care through Group Health’s delivery system, our contracted network, First Choice Health, and First Health Network.

In preparation for implementation of the new benefit category, here are answers to some commonly asked questions.

What constitutes virtual care?

Virtual care is a patient/provider interaction that doesn’t include a face-to-face visit. Beginning in January, it will be billable if it includes a new diagnosis. It won’t be billable if it’s a follow-up visit, such as a patient asking questions about a medication they were prescribed at a previous visit.

What are the costs associated with virtual care?

“There will be positive changes for most of our mutual clients,” says Jan Goetz, senior program consultant for health plan programs. “Our online diagnosis and treatment service, which currently costs $10 out-of-pocket per visit, will become a no-cost service for most members.” Other virtual services are already cost-free.

There are a couple of exceptions to no-cost virtual visits for members. One exception is for those who are covered under a health savings account (HSA) plan. Due to IRS requirements related to these plans, virtual-care visits that involve non-preventive care will be subject to a deductible.

Another exception will be for members of self-funded plans. If a self-funded group chooses to opt out of the virtual-care benefit, their members will be charged the full cost of a virtual-care visit. We anticipate that costs for virtual-care visits will be significantly less than in-person visits.

How will these changes affect providers and patients?

Because of the rapid advancement of virtual-care technology, we anticipate that more of our in-network contracted providers will begin offering—and billing for—virtual-care visits, and we’ll be able to process those bills.

“We’ll be coding all virtual-care visits and tracking utilization, so we’ll have a record of all the care our in-network patients receive, in person and through virtual-care channels,” says Goetz. “This will enhance the continuity of care we’re able to provide.”

Will we be able to differentiate between an office visit and a virtual-care visit?

Yes. Virtual-care channels will have unique codes, so utilization reporting will reflect the difference between face-to-face and virtual-care visits.