The nation's largest employers reported a strong trend toward virtual care options, including telehealth, during the COVID-19 pandemic, according to a survey released Tuesday by the Business Group on Health (BGH).

More than half (53%) of the 122 employers represented in the survey included the implementation of more virtual care solutions among their top healthcare benefit initiatives for 2021. This was the top priority among respondents to BGH's annual survey for the third year in a row, said Ellen Kelsay, the organization's president and CEO.

"There's certainly no doubt that virtual care is here to stay," Kelsay said during a press call. "We've already seen significant traction in the virtual landscape for the past several years and [COVID-19] has done nothing but accelerate that."

BGH has seen an "explosion" of an investment in virtual resources in response to the pandemic, she added, "and that's probably for pretty clear reasons." Stay-at-home orders, for example, required healthcare providers to pivot care delivery as employees were unable to see providers as they normally would have. According to the survey results, 76% of respondents made changes to allow better virtual care access in response to COVID-19, and 71% "accelerated telehealth and virtual care offerings."

At the same time, virtual solutions also appeal to consumers from a convenience standpoint, Kelsay said, and both providers and employees have "very willingly embraced" virtual care. Employee benefits industry sources who recently spoke to HR Dive noted that employee response to virtual care solutions during the pandemic has been largely positive, although hurdles to adoption may remain in the long term.

But for now, the vast majority of employers in the survey see virtual care playing an important role: 80% said they believe virtual care will have "a significant impact on how care is delivered in the future," up from 52% of respondents in 2018.

The mental health connection

Expanding access to mental-health resources was the second most common priority cited by respondents in the survey. As with virtual care, the pandemic has reinforced for employers the importance of mental health and well-being strategies, Kelsay noted.

"This has been a very key area of focus of employers for many years pre-dating the pandemic," she said. "You'd be hard pressed to find a single soul out there who hasn't felt at some point during the recent months some moment of stress, anxiety, isolation or loneliness."

Employers are primarily looking to increase access to mental health resources by directing employees to online resources like apps, videos, articles and webinars, according to the survey results. Slightly fewer than half (45%) said they were working with their health plans to expand mental health networks. Culture is also an area of focus, and 65% of employers named managerial training to recognize mental health issues and direct employees to appropriate services among their strategies for 2021.

As with other areas, virtual care growth has played a large role in mental health. Eighty-eight percent of employers in the survey had virtual service offerings in place for mental health in 2020, and an additional 8% are either adding such services in 2021 or considering them for 2022 or 2023. More than 60% currently have virtual solutions in place for emotional well-being and resilience.

Telehealth can also help reduce the costs of mental health treatment. More than half of surveyed employers said they planned to offer no or low-cost virtual counseling through telemental health next year.

Issues with reimbursements remain

Employers in the survey largely sought to keep virtual-care costs low for employers, particularly during the pandemic. Sixty-nine percent said they waived costs for virtual care due to the pandemic.

But payment parity for virtual care is a topic of conversation for employers, Kelsay said. She added that BGH supports payment flexibility, which may in some cases mean more or less reimbursement for telehealth costs compared to in-person health visits.

"We want to be careful that virtual does not overlay additional costs onto already challenging healthcare cost infrastructure."