Employer-Sponsored Health Centers Provide Access to Integrated Care via a Hybrid of Virtual and In-Person Visits

Abstract

Background: Since the explosion of telemedicine resulting from the SARS-CoV2 pandemic, employers have been particularly interested in virtual primary care as a novel means of expanding primary care services. The purpose of this study is to describe a model of integrated care delivered both in-person and virtually at employer-sponsored health centers nationwide. The key outcomes of this analysis were the proportion of all care delivered in-person and virtually by clinical discipline, the types of care and member satisfaction for care delivered in-person and virtually, and a description of the use of multiple clinical disciplines by the employee population. Methods: Retrospective observational study comparing health services utilization of primary care, behavioral health, and physical medicine services both in-person and virtually in employer-sponsored clinics between January 1, 2020 and June 30, 2021. Results: Of the 331,967 visits with employer-sponsored health center staff, 63% were in-person and 37% were delivered virtually. Most visits were for primary care services (59.5%), with physical medicine visits and behavioral health visits accounting for 25.1% and 15.4%, respectively. Whereas the preponderance of behavioral health visits were virtual visits (72.5%), less than a quarter (18.2%) of physical medicine visits were delivered virtually. 19.6% of patients were seen by more than two clinical disciplines and 2.6% were seen by three different disciplines. Overall, patients were highly likely to recommend the health center across both modalities (Net Promoter Score 89.1 for in-person care and 88.4 for virtual care). Discussion: The future of employer-sponsored integrated team-based care may require a hybrid approach that can lean heavily on virtual visits but requires the infrastructure necessary for in-person care.

Keywords: behavioral health; physical medicine; team-based care; telehealth; telemedicine; virtual primary care.

FIG. 1.

Integrated in-person and virtual care system. This schematic highlights the concepts that the service of geographically distributed employee populations requires combinations of on-site and near-site physical locations with access to virtual care. On-site clinics (represented in yellow) typically serve only the employee population while near-site clinics (represented in red) can serve both employees and their dependents. Depending on the population, more care might be delivered in-person (gray) rather than virtually (green). In addition, some services, such as care navigation/referral management, are best managed regionally (i.e., so that care navigators develop expertise in the highest quality providers in their region), whereas other shared services such as operational and clinical leadership are best managed across the entire organization.

FIG. 2.

Distribution of care by multiple members of the integrated clinical team. The number of patients seen by a single clinical discipline are denoted in light gray, seen by two clinical disciplines are denoted in dark gray, and seen by three clinical disciples in black.

FIG. 3.

Frequency of in-person and virtual visits by clinical discipline. In-person visits are denoted in orange and virtual visits are denoted in blue for each clinical discipline.

FIG. 4.

In-person and virtual visits over the study period by clinical discipline. In-person visits are denoted in blue and virtual visits are denoted in orange for each clinical discipline over the study period.

FIG. 5.

Patient flows through in-person and virtual care. This schematic describes the flow of patients through in-person and virtual care during the study interval. The most prevalent path was for those people who started with an in-person visit and went on to have multiple additional in-person visits. In-person visits are denoted in orange and virtual visits are denoted in blue for each clinical discipline.