VCx is a numbers-driven business. Metrics play a prominent role in just about every decision we make, from strategy to people to our sales processes.

Making a numbers-driven, “ROI” case for virtual care services is something we are well-known for and relied upon to provide. In the case of virtual primary care, for example, justifying an investment in virtual care with sound data is strightforward and usually accepted by our clients on its merits. Supporting data for this type of analysis is easy to find and validate. By focusing on labor productivity (wages and output), a compelling quantitative case can be made to invest in virtual primary care solutions, particularly for part-time employees.

Which brings us to the business case for improving the sleep quality of the workforce.

Given the obvious role that labor productivity plays in profitability, we wonder why more employers are not investing in efforts to combat what is surely one of the most significant drivers of lost productivity: poor sleep.

All of us know, intuitively, that poor sleep makes us struggle to perform at our best. Yet there is little hard analysis on the direct link between labor productivity and the sleep quality experienced by our workforces. We all know that poor sleep hurts our own performance (we postulate that the level of lost productivity across all worker categories due to sleep issues may be as high as 15%), yet there is a dearth of credible analysis and independent research that helps employers understand this critical link — even though some studies show that a lack of adequate sleep may rival alchohol and drug abuse in terms of hourly productivity losses.

There is much to learn about conditions like sleep apnea and other sleep disorders and we encourage all employers to start climbing the learning curve. A good place to gain some practical context is here and elsewhere on the GEM Sleep website. For workers who have employer-sponsored insurance plans, diagnosis and treatment may be an option. But for the uninsured? Not so easy.

Next time you order a ham sandwich from your favorite bistro and what you get back is a falafel, maybe your server just didn’t get enough sleep. The cost of that service miscue is devastating to both the customer experience and the gross margin, to say the least.

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.

This story from Becker’s Health IT newsletter is packed full of meaning for the virtual healthcare sector. Even as the primary care delivery model described in the story would seem to make practical sense (imagine Minute Clinic meets a food truck), the reality of patient engagement patterns for typical non-emergency care snuck-up on this pilot project and (we surmise) decimated its economics. The paradox for primary care innovators might be encompassed in the following Q&A with an imaginary primary care consumer:

Provider: “When do you need primary care?”

Consumer: “When I don’t feel well”

Provider: “And when does that happen?”

Consumer: “Whenever I don’t feel well”.

The DocGo “primary care food truck” is like an airplane needing to fill seats at a certain density and RPU in order to make a profit. But in this use case, there was simply no way to “fill seats” in a predictable way and the unit economics – even at full capacity – were not nearly enough to cover the fixed costs involved.

So what is the takeaway? We actually like the DocGo concept and don’t think it should be abandoned. But the “retail” placement angle probably won’t deliver. Back to the white board!

Or perhaps the Dollar General/DocGo strategy is flawed in a more fundamental way: fully-virtualized care delivery works as a business model since it concentrates care fulfillment while distributing care access. Dollar General/DocGo tried to deploy a model that concentrates BOTH care fulfillment and care access. Read more here.

Most industry watchers were confident that Congress would continue to support innovation related to virtual delivery of healthcare services. While the this demonstration of legislative support for virtual care still has a ways to go before formal approval, the passing of this legislation out of committee is an excellent sign. Read more about this development here. (credit to Becker’s Health)

This is a solid article about rising benefits costs, but we think the comments about “Delayed and Deferred Care” should be a wake-up call for all employers . Anyone keeping track of worker’s true out-of-pocket cost to engage with the health care system knows these costs keep workers from accessing care until health issues are serious. By that point, workers are missing work, losing wages, and no-one wins. In our own research, 50% of workers polled called this issue out. Read the Included Health article here.

Solid research from our friends at GEM Sleep about the very real costs of Obstructive Sleep Apnea. Remarkable that a condition that affects nearly 20% of working American men and women gets so little attention. Yet the ROI on treating this condition should make sleep therapy a must-have option for Employer health care benefits plans. Read more of GEM Sleep’s research here.