Policy reform and rising expectations demand a new playbook––virtual care delivers affordability, access and growth.
Health plans are navigating a period of accelerated change, shaped by sweeping policy reform, evolving consumer expectations and intensifying cost pressures. While the pace can feel daunting, it also creates space for reinvention. In our recent webinar, Teladoc Health experts shared how virtual care enables health plans to turn volatility into opportunity and build a more responsive, resilient future.
Virtual care has shifted from a supplemental benefit to a core component of modern healthcare delivery. Members expect seamless, always-on access—whether for primary care, mental health support or chronic condition management. “This shift signals to lawmakers, regulators, employers and consumers that virtual care is now essential infrastructure,” said Kevin Harper.
Across government and commercial markets, historic policy changes are reshaping how health plans operate and compete. At the federal level, H.R. 1 represents a meaningful shift in how Americans access care. By allowing first-dollar coverage under high-deductible plans, the law broadens access to telehealth. Robin Kingston underscored that affordability remains one of the greatest barriers to care, and virtual care is an essential part of the solution. “Members expect care to be available when they need it without any barriers. First-dollar coverage makes care available through virtual programs at an affordable price.”
H.R. 1 also includes the $50B Rural Health Transformation Program, an investment with the potential to reshape rural health and expand access at an unprecedented scale. As Hunter Sinclair explained, “These investments are a catalyst for change. Telehealth can level the playing field in terms of access by bringing care into communities that need it most, especially when it comes to specialty care or mental health care.”
Additional reforms are reshaping plan strategy. Medicare Advantage regulatory updates are leading to even greater focus on ROI and elevating the role of preventive virtual programs. ACA marketplace subsidy changes are increasing consumer price sensitivity. Medicaid redeterminations are creating churn and coverage gaps that require proactive engagement. Meanwhile, market forces are shifting expectations. Consumers want healthcare to function with the ease of other digital experiences. Demand for GLP-1s and specialty drugs is straining budgets, AI adoption is driving data modernization needs and mental health continues its move toward virtual-first access. “Taken together, these changes are reshaping the playing field faster than ever,” said Harper.
Commercial plans are confronting rising cost pressures, increased member expectations and demand to drive value. Virtual care offers a powerful mechanism to address these pressures. A key opportunity lies in benefit design. By centering virtual care as a core feature—not a bolt-on—plans can reduce early-year barriers to access. “We’ve seen an uptick in virtual-preferred or virtual-first plans because they help members seek care earlier, close gaps and engage more consistently,” said Kingston.
Virtual care also improves care coordination by identifying and engaging emerging-risk and high-risk members earlier. Virtual annual wellness visits, at-home test kits and streamlined referrals support proactive intervention, which leads to better outcomes and more predictable costs. This approach allows plans to create a more cohesive member journey across primary care, mental health and chronic condition management.
Drug spend is another critical challenge. Narrow virtual networks enable access to high-quality providers who ensure appropriate prescribing and ongoing medication management, particularly for GLP-1s and specialty therapies. When paired with digital condition-management programs, plans can simultaneously support adherence, improve outcomes and control overall spend.
Medicare Advantage (MA), Medicaid and Marketplace plans face similar pressures: tight margins, rising medical costs and high expectations for experience and quality. Virtual care aligns with CMS priorities while offering plans a scalable strategy for growth. Virtual primary care and preventive programs help accurately capture and manage risk, positioning MA plans for sustainable performance. Because virtual care improves reach and engagement, plans can close gaps in care more reliably and support members in managing chronic conditions year-round.
For example, one large Medicare health plan that was experiencing low enrollment in the traditional Medicare Diabetes Prevention Program (<100 members) partnered with Teladoc Health to offer a virtual Diabetes Prevention Program (DPP) to increase the share of their members receiving this vital and impactful education. Since that initial partnership, nearly 40,000 MA enrollees have used the Teladoc Health program—a 4% enrollment rate, compared to only 0.01% enrollment in the traditional Medicare DPP. “We’re proving that a different modality can drive consumer adoption and behavior change, and most importantly, life-changing health outcomes for members,” said Sinclair.
Preventive investments deliver both immediate and long-term ROI by reducing avoidable healthcare costs and improving member satisfaction. Policy momentum, including H.R. 1 and major federal investments in rural health, presents major tailwinds. Plans that integrate 24/7 care, mental health services and virtual primary care into their core offerings will be better positioned to meet access standards and member needs. Quality improvement is another strategic advantage. Targeted virtual care programs can drive best-in-class performance on HEDIS measures, from depression screening to diabetes control. Consistent engagement leads to better documentation, earlier detection and more appropriate care pathways.
Virtual care has become a strategic imperative. Policy shifts, regulatory momentum and rising member expectations have created the conditions for meaningful change. Health plans that embed virtual care as a core component of their benefit design—beyond just a supplemental offering—will be positioned to lead. Now is the moment to transform pressure into performance. By acting as a catalyst for better health, virtual care can help build a future-ready, whole-person care model that expands access, strengthens quality and delivers sustainable affordability.
