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Virtual care has been a dynamic area in employee health benefits in recent years and is expected to continue developing as technology advances and plan members search for new ways to access care. Employers and plan sponsors likely need to continuously evaluate their offerings to ensure that appropriate and timely access to care is available to participants and their families.

A recent survey shows that 44% of employers are looking to implement more virtual health opportunities.¹ Though venture capital funding for digital health startups has fallen since its pandemic-induced peak of $29 billion in 2021, it remains at more than $10 billion annually as new products develop and seek support.² Both investment and adoption have reached this critical point; while both have fallen since the pandemic, they remain at elevated levels compared with the pre-2019 market.

When today’s virtual care—or telemedicine—was first introduced to the market more than 15 years ago, it focused primarily on episodic care. Patients used appointments for urgent care, convenience care or an expert second opinion. These were often one-time visits with little to no coordination with other providers in the patient’s care circle (e.g., their primary care physician). Many plans continue to offer this type of virtual care through their insurance carrier.  

Over the last few years, virtual care has shifted toward providers offering longitudinal care, which includes areas such as primary care, specialty care, chronic care and behavioral health care, with the intent of establishing and strengthening relationships with providers and patients (Figure). The market is now focused on care teams that support patients and help coordinate their care.  “Virtual-first” plan design and carrier models are also being introduced, where patients start with virtual care before having an in-person visit. Though adoption is relatively low today, it is gaining a lot of interest. Nearly three-quarters (73%) of large employers are interested in advancing primary care strategy, including virtual primary care and virtual first designs.³

Source: Brown & Brown.

As a result of this evolution, employers and plan sponsors have an opportunity to influence the market and direction of virtual health care. There is great promise in providing more efficient, integrated and higher quality care coupled with increased patient convenience. Virtual care can and has enhanced access, particularly for rural and/or underserved populations who often lack access to preventive, primary care and behavioral health services. For example, following the closure of four prenatal care units rural Minnesota, a health care provider stepped in and provided video visits to serve this population.⁴ This is an example of how health systems have expanded the virtual care landscape beyond traditional telehealth companies and offers a blueprint that is being replicated across the country for many types of care.

Virtual Care Categories

For employers and plan sponsors to thoughtfully evaluate their virtual care options, it’s important to segment the products and identify what offers the best fit for plan participants.

Hybrid solutions that offer in-person and virtual care are likely to be the most impactful, driving better outcomes for patients and plans. From a patient experience perspective, hybrid solutions offer convenience and increased access to virtual care while allowing patients to seamlessly transition to in-person care when and if needed. Effective care is often best achieved when a single platform connects patients to virtual and in-person care, where all case notes, medical history and provider notes are shared.

As employers navigate the myriad virtual care solutions, they may want to consider the following framework based on the models available.

 Virtual Networks

The types of virtual-only networks and the care they provide include the following.

• Episodic telemedicine: Focused on urgent care. Often available through medical carrier partners.
• Virtual primary care: Holistic primary care services provided virtually by a care team. Can be standalone, offered through carrier partnerships or exist as its own third-party administrator (TPA) with health plan capabilities.
• Virtual specialty care: Specific condition-focused care, targeting issues such as mental, musculoskeletal and metabolic health. These services could be available via standalone specialty care telehealth providers or through carrier partnerships.
• Comprehensive care: Offers a network of providers covering a full spectrum of services. These solutions vet and maintain their own network of clinicians or leverage a carrier network. All care is provided virtually.

Virtual Network With In-Person Care

There are two basic types of models in this category.

• Virtual care plus in-person medical group: Virtual care platform that is connected to brick-and-mortar provider groups.
• Virtual care plus retail: Virtual care platform that connects to retail clinics. A similar hybrid solution for patients to access care anywhere while leveraging a large national network of retail stores.

It’s also important to note the organizational structure of these various models. Over the past few years, virtual care products have developed from health plans/TPAs, point solutions, health systems, on-site/near-site clinic providers and individual physician groups.

Drivers and Barriers

Technology development is probably the fastest changing component of virtual care that will impact the future delivery of care. Devices supporting remote patient monitoring help providers “key into” important patient data without requiring an office visit. While technology accelerates and allows more services and diagnoses to be completed virtually, current regulations, guidelines and costs must be considered.⁵

Barriers to virtual care adoption include the following.

• Negative patient perception: Virtual care platforms will need to focus on quality and education to attract patients who may be wary of new technology or desire in-person care.
• Limited comfort with technology: Patients will need to be more tech-savvy when using devices for virtual visits.
• Lack of or low-quality internet connectivity: This can hinder a patient’s ability to connect with their provider, to access medical records, etc.

Other areas impacting virtual care include the following.

• Regulatory environment: During the COVID-19 pandemic, many rules surrounding technology that is deemed secure under the Health Insurance Portability and Accountability Act (HIPAA) allowed previously in-person providers to offer telehealth without investing in new technology. Those regulations are now stricter; provider groups and other virtual care solutions must consider the investment in secure technology.
• Compliance: There are additional compliance barriers specific to licensing that vary state to state. Since virtual care can often be provided across state lines, it’s essential to ensure that proper licensing is in place. During the pandemic some of these requirements were suspended. Those suspensions have since been lifted, and compliance is back to being top of mind.
• Provider reimbursements:  The reimbursement model is critical for further virtual care adoption among providers. They must consider both compensation and time resources. If providers earn significantly less from virtual care compared with in person, they will not prioritize a virtual care offering. Reimbursement within health plans currently varies by carrier. This can affect incentives for virtual care use. Value-based arrangements for virtual care providers are aimed at addressing these disparities.
• Integration of in-person care and medical records: There remain certain procedures and services that must be provided in person. Virtual platforms must seamlessly integrate to that in-person care. In addition, medical records must be shared across all providers within a patient’s care team.

Plan Sponsor Considerations

How do plan employers and plan sponsors factor into this evolving and developing landscape? To maximize investment in virtual care solutions and to guide choices, they may want to establish and/or refresh their virtual care strategy annually. From there, vendor partners can be identified that best support the strategy. The last piece of the puzzle is a solid measurement program that tracks results and evaluates outcomes.

Answering the following questions may help when establishing a virtual care strategy.

• What problem are we trying to solve? For example, is the goal to improve general access to care for the plan population or provide condition-specific support or more convenient care, etc.?
• What problem is the vendor trying to solve? Does this align with the company’s or plan’s goals?  
• What is the target workforce population? Are there certain geographic areas that should be focused on, such as a rural or remote workforce? Are there large sites (manufacturing, distribution centers, etc.) of particular concern?
• What is the desired user experience and will cost or modality impact this experience for our population? Determine what technology is being leveraged and whether it is accessible for a large percent of the plan’s population (financially and from a usability perspective).
• Can virtual care integrate with the other benefits and clinical programs we offer?

Examples of these programs include medical care/case management, leave administration, point solutions, etc.

Once a virtual care strategy is established and key vendor partners are identified and implemented, ongoing measurement, such as third-party clinical assessments, remains a key component of stewardship. A robust measurement strategy will focus on these key areas.

Operational

• Utilization
• Engagement
• Wait time/availability of providers
• Referrals to other benefits/ resources
• Integration with electronic medical records (EMRs)
• Coordination with health plan care management

Clinical

• Preventive service utilization
• Depression/mental health screening results
• Medication adherence
• Care compliance and closing gaps
• Biometrics (e.g., hemoglobin a1c, blood pressure)
• Readmission rates
• Referral patterns to specialists

Financial

• Utilization by condition, population and acuity
• Fixed and variable cost analysis
• Performance guarantees tied to clinical outcomes and return on investment

Member Experience

• Net Promoter Score (NPS)
• Provider satisfaction
• Implementation/account management satisfaction

Outlook

What’s next for virtual care? One area of focus is the further development of hybrid solutions that offer virtual-first care coupled with in-person clinics. Many vendors are also introducing their own health plan and/or TPA for a virtual-first solution. These can be offered alongside traditional health plans (e.g., not necessarily as a full replacement offering). Supplemental and/or coordinating carrier care management is also an avenue explored by new digital health startups offering virtual care. Another trend influencing virtual care is the development of artificial intelligence (AI) as a tool and the related ability to become more predictive and proactive around population health management and outreach. It will be important, however, for employers to track how these virtual offerings impact quality outcomes, engagement and positive user experience.

Overall, the opportunity is clear—Virtual care as a component of a broader health care system can provide convenient and efficient care while increasing access and lowering costs for employer populations.⁶ Integration with in-person care will always be important, but technological developments will pave the way to create a more seamless patient experience.

Endnotes

1. Brown & Brown Employer Health and Benefits Strategy Survey. 2025. ↩︎
2. “2024 year-end market overview: Davids and Goliaths.” Rock Health. ↩︎
3. “Part 2: Health Care Delivery.”  2024 Large Employer Health Care Strategy Survey. Business Group on Health. ↩︎
4. Kevin B. O’Reilly. “7 ways telehealth is reshaping medicine for the better.” American Medical Association. April 5, 2024. www.ama-assn.org/practice-management/digital-health/7-ways-telehealth-reshaping-medicine-better. ↩︎
5. Mitchell Tang et al. “How to Tap the Full Potential of Telemedicine.” HBR.org. June 5, 2023. ↩︎
6. Gentili et al. “The cost-effectiveness of digital health interventions: A systematic review of the literature.” Frontiers in Public Health. August 11, 2022. ↩︎