Employers know all about the rising costs of their employee health benefit plans. KFF’s 2024 most recent survey (released October 9th) will only confirm what they already know: Premiums are up 7% in 2024 and up 24% over the last 4 years. Average annual premiums in 2024 will reach $25k for family plans and $9k for individual plans.

What continues to be interesting is that employees are not exactly jumping up and down about how they percieve the value of such benefits — the primary reason being the “nickel and dime” co-pay regime that employees must pay that cost the employee from $30 to $100 per visit until they reach their annual deductable limit (which averages $3000). 60% of insured employees indicate they avoid accessing benefits due to the high per-visit co-pay charges.

And this data relfects private insurance sponsored by employers. When an individual opts to purchase a qualified plan on a state exchange, the lowest cost plans also have the highest deductable thresholds which means (in most cases) the deducatable threshhold will likley never be met and the co-pay pain never ends.

In our review of medicare reimbursement rate data (which is a decent proxy for reimbursement rates in general), it also appears that primary care consults when delivered virtually (eg, through telehealth) are reimbursed (ie, reimbursed to doctors and practices) at the same rate as in-clinic visits! In fact, in-clinic primary care visits are reimbursed at rates between $140 and $220 per visit. At first glance, this defies all logic.

Virtual healthcare delivery (eg, telehealth) has many, many useful benefits for patients seeking general primary care. At VCx, we look forward to the day when the true cost efficiencies of virtual care delivery actually end up being reflected in what patients end up paying for these services.