Doctor on Demand partners with Texas health plan for virtual primary care HMO - Healthcare Dive

Dive Brief: 

• Telehealth vendor Doctor on Demand is partnering with Texas-based Community Health Choice to launch an HMO plan on the state's Affordable Care Act exchange that focuses on virtual primary care.
• The plan targets patients who don't qualify for Medicaid or Medicare coverage in Texas, one of 12 states that has not yet expanded Medicaid under the ACA.
• Patients on the plan will have a primary care physician and access to video visits for preventive care, urgent care and behavioral health. They'll be referred to in-network providers, specialists, facilities and programs within Community Health Choice.

Dive Insight:

Several months after telehealth use skyrocketed due to constraints of the COVID-19 pandemic, patients are still turning to virtual visits to manage many of their health conditions. Doctor on Demand is looking to capitalize on the boom, partnering now with a plan that highlights virtual visits and basic services.

The latest play is in line with other inroads the company has made as the pandemic rages on. In May it became the first telehealth vendor to enter the Medicare Part B market. A month before that, it entered into a contract with Massachusetts to provide free virtual visits to people in the state who are on Medicaid or uninsured during the COVID-19 crisis.

While the ultimate staying power of telehealth remains unseen, it is likely at least some increased coverage by Medicare and commercial insurers will remain. And research has shown patients mostly approve of the option.

Texans falling through the coverage gap can now enroll in the "Virtual Bronze" plan to see a primary care doctor through video visits, the companies said. If an in-person visit is necessary, they will be referred to a specialist within the network.

While virtual care took off amid the pandemic, it also led many to delay care or miss annual check-ups with primary care providers.

"Right now there aren't a lot of guidelines around where they should go and how they should manage their care," Doctor On Demand's head of growth and strategy David Deane said. "People have stepped away from the whole environment of having a primary care physician that can provide this care navigation, and I think that's the value we bring."

Patients will also have access to behavioral health visits, physician house calls and a nurse phone line, Deane said.

It's unclear how many Texans are expected to sign up for the "Virtual Bronze" plan, but the state has a major coverage gap — more than 760,000 residents aren't eligible for Medicaid or premium subsidies to offset private exchange coverage costs, according to data from the Kaiser Family Foundation.

Thirty-nine states and D.C. have expanded Medicaid under the ACA while 12 have not. Last year, two states — Oklahoma and Missouri — approved ballot measures to expand Medicaid.

Doctor on Demand has a number of virtual primary care plans in the process right now, including some rolling out later this year, according to Deane. "It's a need. These bronze level plans, particularly the ones that are affordable, they pick up a part of the population that's been underserved," he said.

Correction: This article originally misspelled David Deane's name.

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Doctor on Demand partners with Texas health plan for virtual primary care HMO - Healthcare Dive
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