Virtual care has transitioned from a temporary clinical alternative into a permanent pillar of health system infrastructure. According to the Telehealth benchmark survey results, Virtual Care in 2025: Hospitals Look to Scale Effort published by Teladoc Health, a fundamental shift is occurring in how provider systems approach telehealth.
Rather than launching uncoordinated new platforms, health care systems are prioritizing and scaling their core virtual care programs to serve a broader patient base through integrated hybrid models. This stabilization and scaling of provider-led virtual care introduces critical financial considerations for healthcare executives.
The report also highlights that 100% of surveyed hospitals and health systems now offer virtual care or will by the end of the year. As health systems expand their virtual care footprint to manage chronic conditions and triage patient populations, the traditional boundaries of care delivery blur.
Payers can no longer afford to manage virtual solutions as siloed, independent add-on benefits. To protect the medical loss ratio and ensure continuity of care, plans must fundamentally mature their approach to provider network contracting.
Navigating Bidirectional Integration and Cost Shifting
A primary goal for mature telehealth programs is achieving deeper integration between digital platforms and traditional brick-and-mortar facilities. Health systems are leveraging these integrated networks to optimize provider capacity, streamline outpatient services, and drive institutional efficiency. If a payer lacks transparency into how these virtual encounters are integrated and billed, the system can inadvertently introduce new forms of cost leakage.
When a health system shifts a standard, low-overhead virtual visit into a hospital outpatient department billing structure, the unit cost can escalate dramatically due to facility fees. Without forensic oversight, insurance plans often absorb these premium rates for services that should technically reduce total medical expense.
Managing this risk requires moving past baseline contract adequacy and embedding precision definitions into your provider network contracting agreements. Payer systems must verify that the shift toward scaled virtual models translates to shared efficiency gains rather than hidden provider margin optimization.
Health care organizations must establish clear parameters regarding how virtual visits are reimbursed relative to in-person services. Ensuring that telehealth delivery is tethered to objective, market-validated benchmarks prevents health systems from using digital expansion to bypass standard rate agreements.
Capturing Savings in Mature Virtual Networks
The survey also reveals that a record 35% of surveyed health care organizations have had virtual care programs in place for more than five years. Crucially, the data shows that efficiency gains and savings are relatively more important to these mature organizations than to those with newer programs. As health systems successfully consolidate their technology stacks and streamline virtual workflows, the actual cost of delivering care decreases.
However, legacy insurance contracts rarely feature mechanisms that allow payers to share in these provider-side efficiencies. If a plan is bound to outdated, fee-for-service terms, the health system captures the entirety of the savings while the payer continues to pay premium baseline rates.
Updating your approach to provider network contracting allows your organization to align reimbursement with these streamlined workflows. By restructuring agreements to reflect the lower overhead of mature hybrid care models, health plans can actively reduce unit costs while supporting high-value, coordinated care pathways.
TOG’s Perspective: Strategic Actions for Payers
Successfully managing the expansion of health-system-led virtual care requires integrating digital utilization metrics directly into your network strategy. TOG Network Solutions suggests the following operational actions for health care plans:
- Delineate facility fees from virtual billing codes. Ensure your provider network contracting terms explicitly prohibit the application of hospital outpatient department facility fees or administrative markups to routine virtual visits.
- Restructure contracts to share in provider efficiencies and incorporate terms that adjust reimbursement rates for mature, integrated digital programs. Ensure that the operational savings reported by health systems are accurately reflected in your plan’s medical spend.
- Require contracted systems to integrate virtual visit documentation directly with your care management platforms, preventing duplicate diagnostic testing and keeping member care transitions within your preferred network.