Ensuring access to quality healthcare is an ongoing and expensive challenge for health plans. Virtual care has the potential to improve healthcare access and quality while lowering costs.
TytoCare works with commercial health plans across the US. TytoCare leverages advanced technology and a member-centric approach to make healthcare more affordable, convenient, and accessible.
One of our customers is a top-3 national health plan who wanted to implement a virtual care program for commercial members. They sought to lower healthcare costs while improving access to care, quality of care, and member retention. We partnered with the health plan to bring our virtual care solution, the Home Smart Clinic, to 60,000 members across 29 states.
A key way to lower costs is to minimize unnecessary visits to the ED by members who were unable to access care through a doctor’s appointment. Virtual care could fill this gap, allowing members to access urgent care for acute, non-emergency concerns from the comfort of home, which is more convenient and cost-efficient.
The health plan wanted a virtual care solution that would go beyond traditional audiovisual telemedicine, allowing high rates of visit resolution without the need for in-person follow-up care. This approach would improve care quality and accessibility while lowering healthcare expenses. The improved care experience would also enhance member retention.
TytoCare worked alongside the health plan to set virtual care objectives that aligned closely with the health plan’s business goals. The virtual care program’s objectives were as follows:
Cost of care – Shifting care to the home, a more efficient care site, and reducing total cost of care
Quality of care – Improving clinical performance for better care quality and enhanced outcomes
Member retention – Enhancing the care experience by providing care that members love
TytoCare rolled out its virtual care solution and employed a strategy aimed at meeting the health plan’s key business goals. The health plan’s existing virtual care providers used the Home Smart Clinic to provide immediate care to members and more accurate diagnoses.
Here’s how partnering with TytoCare enabled the health plan to achieve its objectives:
Cost of care reduction
Total cost of care for the health plan was reduced by 5% with TytoCare. For every 1,000 members (children), 2.7 fewer members visited the ED for urgent, non-emergency issues per week.
Improved quality of care
The accuracy of ICD-10 codes diagnosed using TytoCare’s remote physical exams was compared to codes diagnosed with audiovisual-only telehealth. TytoCare allowed doctors to diagnose and treat patients with greater accuracy. It enabled more timely resolutions without the need for in-person follow up care.
Better member retention
An NPS score of 80+ indicated strong member satisfaction with TytoCare’s virtual care program. Thanks to TytoCare, members reported that they were 67% more likely to stay with their current insurer in the long term. As member Leanne from Los Angeles put it, “I was very happy with our coverage beforehand, but this has put a value on it that is extraordinary.”
The Home Smart Clinic allows health plans to easily bring virtual care into their existing care delivery frameworks using TytoCare’s carefully designed program, remote physical exams, and workflow integration. TytoCare also offers software connectors that streamline integration with EHRs.
TytoCare’s Home Smart Clinic is our FDA-cleared, handheld device that includes a camera and thermometer, otoscope adapter for ear exams, stethoscope adapter for lung and heart exams, and tongue depressor adapter for throat exams. These tools enable families to get immediate, data-based diagnoses for multiple conditions, including respiratory conditions, ear diseases, eye disorders, and skin conditions
Also included is Tyto Insights™, which provides AI-powered guidance and decision support, provider integrations, and Tyto Engagement Labs™, which provides engagement framework and member journeys.
The right cohort is critical. In this study, the health plan worked with TytoCare to apply the insights gleaned from the Tyto Engagement Labs™ to select a suitable target cohort. Factors such as family structure, medical history, ED and urgent care utilization, telehealth experience, and predicted cost of care were taken into consideration. Families’ healthcare engagement were combined with the predicted cost of care per household to arrive at a family score, reflecting the likelihood of the family to adopt the virtual care solution.
The path to success begins with a comprehensive plan. In this study, the health plan leveraged Tyto Engagement Labs™ to build a user journey designed to encourage behavioral change.
Tyto Engagement Labs™ is TytoCare’s proven framework for success. It was developed using the latest in behavioral science research and years of successful deployment of our solution across the US and around the world.
The health plan used Tyto Engagement Labs™ to identify a select cohort for virtual care rollout. Each family selected for the cohort received a TytoHome device, allowing them to carry out remote physical exams from home. Tyto Engagement Labs™ also optimized adoption and utilization to help maximize a successful outcome.
The plan incorporated multiple channels along each stage of the journey, including physical, digital, and product-based approaches. Chris from Santa Monica said, “I appreciate how easy it was to get started with TytoCare. There were tutorials for practicing vital information collection and sending it to the doctor.”
Tyto Engagement Labs™ drove high adoption rates of TytoHome among members by establishing a mental model. For example, over half of members who completed the enrollment quiz went on to enroll in the program. The delivery communication strategy capitalized on first day momentum and increased early set up rate by 43%.
The health plan experienced significant success with TytoCare’s virtual care program. They plan to scale up and offer TytoCare to a larger population of commercial members based on the characteristics identified for the initial cohort. They’ll use findings gleaned from this study to expand the offering of virtual care to Medicaid cohorts and other programs.