Q&A: Premera Senior VP on removing the limitations on virtual care

Premera Senior Vice President Rich Maturi sits down with State of Reform to talk about big changes at Premera in 2015—namely, the insurer’s decision to make virtual care a regular, covered benefit for its members starting this month.

Telehealth provides a way for patients who are geographically challenged or time strapped to have regular office visits via video conference or phone call. The practice of insurers and employers utilizing telehealth services is nothing new. According to Maturi, what is innovative about Premera’s virtual care offering is the organization’s guiding mission in 2015 to remove payment limitations and allow consumers to receive and be billed for telemedicine as they would a regular office or urgent care visit.

Premera Location Portraits

Rich Maturi, Senior Vice President of Premera Blue Cross / source: Premera

JJ: Hi Rich, thank you for joining us. So how long has Premera been thinking about telehealth, and what went into the decision making process to offer it as a covered benefit?

RM: We have been looking at telehealth and anticipating the emergence of virtual care for a number of years. It comes up in various conversations and contexts. But part of the challenge has been setting up the infrastructure on the provider side to actually schedule, conduct, and bill a telehealth visit. It is a change in the delivery system that is still developing.

What we saw emerging, about a year ago, were these national organizations that had, in essence, constructed the first generation networks for telehealth. So the actual, formal project within Premera started. We decided that we would move forward and simultaneously change our benefits, starting 2015, including a change to our payment policies. At the same time, we would use an organization such as TelaDoc to ensure that we had the capacity to service our members while the local provider community developed these types of capabilities.

From there, we conducted a competitive RFP process, selected TelaDoc, and moved forward. It’s really been in the last year that we’ve taken these steps, we know that telemedicine is the future, and we’ve been eyeing it for a number of years.

JJ: What was the impetus that drove Premera to act in 2015?

RM: We think that there will be more care delivered in ways other than on a face-to-face basis in the future. There’s going to be more home monitoring. There are already situations out there where patients in ICUs are monitored remotely by physicians in other locations. There’s going to be more applications for this [technology] going forward.

Really it was [a question of] what is the first big step. To Premera, when you have national organizations, such as TelaDoc, developing broad networks that we can offer to both our local and national customers, that’s the first step. That precipitated us to move along and make the service available to our members at the level of routine office visits and urgent care. We plan to build from this going forward.

JJ: What population in Washington state will benefit most from this change?

RM: We believe that a lot of different people, in many settings–rural and urban–will benefit. The two types of situations that may be the most prevalent initially are the people who are asking “Do I need to go to an urgent care center? Do I need to go to an emergency room? Can I get a consultation before I do that?” and also people who are in some way geographically restricted. [For example], the mom who has a sick baby in the middle of the night, or people that have to rely on public transportation or who have difficulty getting away from their work to schedule an office visit for some short-term concern that they have.

Initally, we believe virtual care will be adopted for low level, episodic care for people that find it challenging to schedule a face-to-face office visit during the day.

That’s [the case] initially. But if you think about the way that we shop, we shop online. With that in mind, we think that people will receive more health care online over the next decade.

We think it’s an overall transition. There are already providers who are working on this. Providers who are really learning and thinking about how to push the envelope in terms of what kind of care can be effectively delivered this way. It’s going to make sense for everybody to receive more care this way in the future.

Premera Virtual Care

Virtual care allows patients to talk to doctors via mobile device / source: Premera

JJ: Is Premera offering any incentive for physicians to participate in the program?

RM: In a survey of providers, 20 percent of providers told us that they had some [virtual care] capability. I haven’t seen evidence in our actual interaction with them that [20 percent] have capabilities relative to what we’re talking about. A lot of them, for example, currently have email.

In this survey, we were not qualifying providers. We were just asking them the question [of capacity]. We’re not building [incentives in], other than paying for the visits in the same way that we do for other services. That is an incentive.

In past attempts, people tried to custom design billing mechanisms for [telemedicine] service. We think the incentive is really going to come from their patients in the marketplace and from creating a lower cost, yet more efficient way to deliver care from those providers.

There are providers out there who will look at this and think “I am more likely to attract the loyalty of patients if they know they can reach out to me to get these types of services.” So I think it is a competitive incentive that will emerge once local providers begin [participating].

JJ: Will the program involve specialists or just primary care physicians?

RM: The way we have structured it, any provider that is providing a visit, which are not specialty specific, under the guidelines we provide, can bill us for this service.

In principle, there are certain types of follow-up care that a specialist could provide that don’t require a face-to-face office visit. However, we expect most of the initial visits to come from primary care providers.

JJ: What are the costs for Premera to use TelaDoc services?

RM: I can’t go into the contract details, but in general the payment levels for virtual office visits are less than the payment levels for the equivalent face-to-face office visits, simply because they require fewer resources on the part of the provider. Even though we think we’ll have some telehealth visits that would not have occurred as face-to-face visits, on a net basis we believe we will produce some cost savings for our members.

Virtual care is beneficial and convenient. When you think about quality broadly, if I don’t have to bundle up my sick baby in the middle of the winter and bring him or her to an urgent care center for something that could have been treated over the phone, that’s actually better quality. It’s also fundamentally more efficient and therefore that produces a better cost.


Teladoc services will be coordinating with Premera in 2015 / Source: Teladoc

JJ: Is Premera’s program unique in the region?

RM: There are other health plans that have contracted with Teladoc and similar organizations to offer telehealth services. There are also large employers that have contracted directly with an organization like Teladoc. I don’t know if there is anyone else in Washington State that has taken the position that we have, regarding removing this benefit restriction across the board and constructing it to not just be available just through a vendor such as Teladoc but also from the local provider community. Basically, we are approaching it as “this is just another form of health care. We’re going to make it available to our members.”

We asked ourselves a question a little over a year ago when we approached this [idea]: “Do we think of this as some sort of special disease management program? Something outside the norm of health care? If this how we want to think about [telemedicine], we would just go and do a contract with a tele doctor. Or “Do we think of this as another way to receive health care?” The latter was the case and the reason we approached virtual health the way we did.

JJ: What’s on your radar for the future of Washington health care?

RM: From my perspective of being responsible for Premera’s provider relationships, there will be more population-level accountability being taken by providers or networks of providers in the future. It makes more sense to providers from their business and operating model to say “I’m not just responsible for delivering individual acute services; I want to take responsibility for taking care of the health of a population of people.” And there will be more forms of arrangements and products that fall under that general category.

Associated with that [transition], will be some combination of consolidation or networking, more providers working together–and the extreme of working together is merging–but there will be many opportunities short of that for providers to collaborate and combine resources on how to develop practice guidelines and look at data and put case management in place to be able to manage population health.

Those are the two big things that we see happening.

JJ: Thank you so much for your time, Rich.

RM: Thank you, JJ.