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

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.