What Is Virtual-First Design?
Virtual-first plan design makes telemedicine the default first step for non-emergency care. Instead of going to an urgent care center or ER for a sinus infection, the employee first tries telemedicine. If the condition cannot be treated virtually, the telemedicine provider refers the employee to in-person care.
Virtual-First Incentive Structures
| Incentive | How It Works | Impact on Utilization |
|---|---|---|
| $0 telemedicine copay | No cost-sharing for telemedicine visits | High — removes financial barrier |
| Higher ER copay for non-emergencies | Higher cost-sharing for ER visits that could have been telemedicine | Medium — creates financial incentive to use telemedicine first |
| Telemedicine-first requirement | Require telemedicine consultation before ER or urgent care (except emergencies) | High — but requires strong member support |
| Telemedicine wellness incentive | Reward employees for using telemedicine | Medium — positive reinforcement |
Virtual-First Plan Products
IQ Insight
Several carriers now offer virtual-first plan products that integrate telemedicine into the plan design. These products typically feature $0 telemedicine copays, a dedicated virtual primary care provider, and care coordination between virtual and in-person care. Virtual-first plans typically cost 10–20% less than comparable traditional plans — making them an attractive option for cost-conscious employers.