Hiding in Plain Sight: The Rise of In-Network Virtual Providers and Clinics

 

Virtual specialty providers and clinics continue to expand in the market, increasing access and the range of services that can be delivered through virtual care. Today’s virtual networks support everything from women’s health and lactation to digestive care, physical therapy, dermatology, and specialized behavioral health services. As virtual care becomes more established, health plans are increasingly embedding these providers directly into their own networks.

On the surface, this creates a meaningful opportunity for employers of all sizes and for employees to access innovative solutions. These virtual providers operate like traditional in-network providers in that they bill claims through the health plan, require no additional employer contracting, and involve no added fees. In practice, however, these resources are often hiding in plain sight. Employers and plan members often lack awareness of, and visibility into, these providers, and a clear pathway to access them.

¹Rock Health’s Consumer Adoption of Digital Health Survey (2024 and 2025)

Why Should Employers Care? What’s the Value to Plan Members?

In-network virtual providers offer valuable clinical services, along with addressing common challenges such as access, availability, stigma, and quality.

• Expanded access: Virtual providers help fill gaps caused by provider shortages, long wait times, or a lack of local specialists
• Greater convenience: Remote access and expanded hours help increase engagement, timely care, and reduce care avoidance
• Reduced stigma: Members dealing with sensitive conditions such as behavioral health issues, may be willing to seek support virtually, leading to improved outcomes
• Quality: Providers are credentialed and trained to meet specific conditions and needs, often treating and managing the patient throughout the care journey

Why “Available” Doesn’t Always Mean “Accessible”

Unfortunately, the availability of virtual providers within the network does not necessarily mean they are accessible. Employers and employees often do not know they have access to these providers or how to find them, for several reasons:

• Health plans’ provider search engines and algorithms may not allow for finding virtual networks as seamlessly as finding traditional brick-and-mortar providers. Members may have to take additional steps to find virtual providers, creating a barrier and confusion.
• Members may not fully understand that virtual providers are in-network and covered by their health insurance.
• Virtual clinics vary in availability, with some nationally available and others regionally available, creating communication complexities.

How Employers Can Make the Most of In-Network Virtual Providers

Employers can take steps to ensure their workforce fully benefits from the breadth of available in-network providers, including those that are virtual, by proactively engaging with their health plans.

Key actions employers can take include:

• Partner with health plans to inventory the in-network virtual providers for the plan and understand the services they offer.
• Learn how members access these services — including search and navigation steps — and work with health plans to address barriers employees may encounter.
• Integrate virtual care resources into ongoing employee communications to increase awareness and make these options more visible and familiar.
• Develop targeted communications that highlight available virtual providers that align with the organization’s healthcare strategy and workforce needs, such as focusing on:
  • Under treated conditions or lesser-known resources (e.g., mental health, digestive health, chronic pain)
  • High-cost drivers (e.g., MSK, metabolic conditions)
  • Workforce specific needs (e.g., women’s health, men’s health)

Questions to Ask Health Plans

To uncover and maximize these built-in providers, employers should work with their benefits advisors and carriers to understand:

• What virtual clinics or digital health solutions are embedded as in-network providers for the Plan?
• Are there actions needed to activate any of the virtual networks?
• How are services billed to the employer and the member?
• How can the employer promote the solutions? What support and resources are available for communicating with employees?
• Are the virtual providers in the health plan’s search engine? How can members search for and access them?
• Are the health plan staff (care coordinators, care managers) trained on these providers? Do the plan’s referral systems integrate these providers?
• Are there limitations to be aware of (e.g., visit limits, geography) unique to these providers?
• What reporting will be available from virtual providers to monitor engagement, health outcomes, and financial impact?

Note that these in-network providers are not to be confused with buy-up virtual solutions, such as point-solution partners in the carrier’s ecosystem that employers can add on with additional costs.