Teladoc introduces new virtual care model that links payments to outcomes for companies and health plans

Teladoc Health announced a new virtual care model that will provide a more personalized experience for members and tie payments to clinical and financial results for employers and health plans.

The model, dubbed Teladoc One, was created to supplant disjointed, disease-specific health care programs with a more integrated system that can dynamically address a person’s total health care needs, not just a single disease at a time, company executives said. Teladoc Health care teams provide and coordinate care in virtual environments and in collaboration with a member’s local provider(s) as part of the model.

In essence, “Teladoc One” is a new care model that’s transforming the way care is provided, Kelly Bliss, president of U.S. Group Health at Teladoc Health, said in an interview with Fierce Healthcare.

Teladoc One was created in collaboration with a limited number of health plans and employers, initially for populations that have cardiometabolic diseases. Programs under the Teladoc One model will launch with an initial group of enterprise customers in September, and it will be generally available in January 2027.

Employers are in a “sea of point solutions,” Bliss said, as they also are grappling with increases in healthcare expenses that add financial pressures.

Costs to employers and health plans are not sustainable, as about $4.7 trillion is spent annually on the three in four Americans who manage at least one chronic disease, Bliss said.

For years, virtual care has been treating individual diseases and conditions, and that hasn’t changed the trajectory of health outcomes or cost of care; now, many employers are signing a variety of point solutions, and it’s created siloed health — siloed health data, siloed health outcomes — and risk is being identified too late because no one particular organization has a full picture of the individual.

A new model with clinical breadth and “structural agility” to intervene medically in a variety of ways across a variety of specialties and care modalities, and to maintain a longitudinal relationship with the member, is needed to overcome these challenges, Bliss said.

As the largest multi-specialty virtual care practice in the U.S., Teladoc Health has the capabilities, clinical and behavioral data, and expertise to provide a new model for employers and health plans, Bliss asserted.

The company has provided 100 million visits across primary care, mental health, chronic illness, and acute care. The company says Teladoc Health has been working on the technical and infrastructure foundation for Teladoc One for the past two years and has a significant data repository of virtual care data.

The platform utilizes Teladoc Health’s Pulse intelligence engine, which combines clinical history, claims, pharmacy, device, medical record, engagement and eligibility data. These data insights help care team members recognize trends, act, coordinate care, facilitate specialty referrals and enhance member results, Teladoc executives said.

“Teladoc One is designed on a primary care chassis, so we can provide more personalized care and support you in getting care more dynamically across a range of needs rather than being constrained by a digital health point solution with a limited set of programmatic interventions to provide you care,” Bliss said.

The Teladoc One model is designed not only to improve clinical outcomes but also to reduce the overall cost of care, with 100% of fees on the line.

Ethan Berke, Teladoc Health’s chief medical officer, told that the metrics for success will be “improvements in condition control, medication adherence, care plan engagement and follow-up, and a reduction in medical costs, unnecessary referrals, ER visits, hospitalizations, and more appropriate medication and site-of-care decisions. As a result, Teladoc One’s success relies on delivering validated medical cost savings and improved clinical outcomes, with 100% of fees at risk.

An important aspect of the model, Berke said, is that the Teladoc Health care teams work alongside members’ current providers, in addition to the care they receive from their brick-and-mortar primary care physicians and specialists.

To cut down on fragmentation and improve continuity, care guides and clinicians coordinate care referrals, share clinical information via health information exchanges and secure provider messaging, and follow up to ensure patients successfully make the transition to in-person care as necessary.

So, if one of the care team’s NPs identifies that an alternative medication is more suitable for the patient, she is reaching out directly to the patient’s brick-and-mortar PCP to flag it, he said, and “all of those outreach calls to a member’s brick-and-mortar PCP have been welcomed by the external providers.

To patients, the model is used to aid personalized care pathways, with new functionality that matches patients to the appropriate level of care optimised for cost and need. The care model was built to be connected, adaptive to provide proactive, always-on care and guidance, according to the company.

Let’s assume a person is suffering from hypertension, weight issues, and high stress. They don’t have to go through individual programs; they have one connected care experience,” Berke said. The care team can monitor their health information in real-time; AI can send reminders and check-ins between visits; the care team can arrange for medication, nutrition support, behavioural health or specialist referral as needed; and in-person care is arranged directly for a seamless experience.

The launch is part of Teladoc Health’s strategy to enhance its integrated care offerings. Two-thirds of Teladoc Health clients are using two or more products. A recent study of over 29,000 Teladoc Health members participating in multiple chronic health programs revealed that those who were participating in both chronic care and mental health care have significantly greater decreases in blood sugar and weight loss.

Patients are cared for by a multidisciplinary virtual care team of licensed clinicians, certified health coaches, registered dietitians, mental health therapists, and specialists. Patients are provided with a care guide who holds them accountable to their care plan and escalates to other care team members as needed, in coordination with their in-network primary care and specialists.

Teladoc Health also created AI assistance to interact with members between health care team visits to provide reminders, appointment scheduling, and individual health checks.

Teladoc Health creates clinical profiles of patients in the model using clinical history, claims, pharmacy records, medical records, connected devices, Health Information Exchanges (HIEs), biometric data, engagement history, and patient-reported preferences, Berke said.

“This dynamic profile can be used to continuously assess and monitor risk, detect issues sooner, engage in proactive intervention before a patient’s condition deteriorates, and provide the care team with relevant clinical and behavioral information before a patient interaction.” This translates to a more proactive, personalized approach to care that has the potential to enhance health outcomes, increase patient engagement, and reduce preventable hospitalizations, but most importantly, it empowers the care team with the support of AI, with licensed clinicians still making all diagnoses, treatment decisions, and handling direct patient care.

Teladoc has introduced an innovative virtual care model that aligns payments with measurable health outcomes rather than the volume of services provided. The new approach is designed to help employers and health plans improve care quality, reduce healthcare costs, and deliver better long-term results for members. By emphasizing value-based care, Teladoc continues to strengthen its position as a leader in digital healthcare innovation.

A Shift Toward Value-Based Virtual Care

Traditional healthcare reimbursement models often focus on the number of services delivered. Teladoc is moving beyond this approach by connecting financial incentives to clinical outcomes, encouraging providers to prioritize patient improvement and long-term wellness. This value-based strategy aims to create a more sustainable healthcare system for organizations and their members.