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As more services become available for employees to consult with doctors online or over the phone, employers have some important decisions to make about whether to offer these options as a benefit and, if so, whether they or their employees should pay for it.
In general, telemedicine occurs in two ways. The first involves an individual patient speaking to a physician via a Skype-type video stream (preferably) or by phone to obtain a diagnosis and treatment. This is also sometimes called telehealth, and the individual patient initiates these appointments. The arrangement is often less expensive than an office visit and more convenient to individuals who are seeking care after hours or who cannot easily go to a doctor’s office for whatever reason.
The second type of telemedicine involves communication among physicians and specialists to discuss a patient’s care. Health care providers initiate these interactions, although the patient may also be involved in some of these sessions.
Focus on Cost Savings
Not surprisingly, the main attraction of telemedicine is its potential to save money and streamline health care access. An
analysis by consultancy Towers Watson identified the cap on potential savings from telemedicine in the U.S. at $6 billion annually. Granted, this number represents the savings that could be realized if all employees and dependents use telemedicine whenever appropriate, instead of in-person visits to a doctor’s office, emergency room or urgent care facility.
Although such a scenario is still a long way off and may not even be attainable, that $6 billion figure shows the significant potential for savings for employers that make any headway at all in this direction.
Telemedicine has the potential to save money
and streamline care access—if it’s used, when
appropriate, instead of in-person visits to a
doctor’s office or emergency room.
Beyond cost savings, employers can also look to telemedicine to improve employee productivity and reduce absenteeism. The rationale is that a telemedicine visit is far less time-consuming than taking time off from work for routine doctor appointments involving nonthreatening health issues. This is especially true for employees who are caregivers and need to coordinate care for themselves as well as children and elderly relatives.
If telemedicine can reduce lost work time and lower health care costs, it could pack a potent one-two savings punch—especially when it involves the health and well-being of individuals with chronic and potentially debilitating conditions.
“An employee who is chronically ill with diabetes may have frequent hospital admissions if their condition is not well-managed and they don’t have the decision-support tools for self-care,” said Richard Bakalar, a managing director with consultancy KPMG LLC. “Supervised care through telemedicine can be very effective in reducing hospitalizations or reducing lost work time because of complications due to inadequate supervision or compliance.”
Putting Telemedicine to Work
Currently, the use of telemedicine programs is not widespread. The Towers Watson analysis found that just 22 percent of the 379 large U.S. employers surveyed (those with at least 1,000 employees) currently offer telemedicine programs to their workers. However, interest in these programs is growing, with 37 percent of large employers expecting to offer telemedicine consultations in 2015 and 34 percent in 2016 or 2017.
HR consultancy Mercer
reports “a surge in offerings of ‘telehealth’ services” in 2014, from 11 percent to 18 percent of all large employers – and from 18 percent to 34 percent of jumbo employers.
Insurance carriers are also moving toward offering telemedicine. Anthem Blue Cross/Blue Shield rolled out its telemedicine tool to its national employer customers in 2013 and, more recently, began offering the option to the majority of its customers, including individuals purchasing coverage on the public health insurance exchanges. The telemedicine service works on a computer or hand-held device, such as a smartphone or tablet, and allows live video access to a physician who can diagnose, treat and write prescriptions for nonemergency health care needs. The service, which is available 24 hours a day, 365 days a year, including holidays, is also available to non-Anthem customers for $49 per visit.
Similarly, Wellpoint’s LiveHealth Online service is
described in this video report.
There are also other telemedicine programs available through third-party vendors such as Doctors on Demand,
whose Web-based application is described in this demonstration video, and they often price their services on a per-employee basis for unlimited annual access based on the size of the organization. The per-employee fee can get as low as $120 for employers with about 1,000 or more employees, according to Asher Epstein, chief operating officer of Access Health Group, a telehealth provider in Bethesda, Md. However, programs for smaller employers can run between $200 and $300 per employee. Employers can also opt for a per-session fee, usually between $30 and $50, which is paid either by the employer or by the individual employee.
In cases where an employer already has an onsite health clinic for employees, telemedicine could be integrated into the clinic’s care. In this case, it would be the health care providers themselves who decide whether using telemedicine is appropriate for an initial examination of a patient or to determine if further treatment with a specialist is warranted.
Getting Employees on Board
Telemedicine’s effectiveness as a way to access health care and save money will only be as strong as employee use of these services. So far, utilization numbers are low, with vendors generally claiming per-member utilization of less than 10 percent, according to Towers Watson’s research. “Getting individuals to try telemedicine services the first time is the challenge,” said Epstein. But “once people use the service, repeat usage is pretty much guaranteed.”
Employers with a technology-savvy workforce are likely to have an easier time getting employees to try a telemedicine service. To bring others into the program, employers can emphasize convenience, which should be particularly attractive to working parents with little time to take their children or themselves to doctor offices. Epstein noted that first-time telemedicine use tends to occur after hours—for example, when parents who have a sick child or are ill themselves cannot easily leave the house for care.
Communication about telemedicine as a benefit can focus on the availability of the service during these types of situations. “Telemedicine can also be helpful for mobile workforces where people travel a lot, such as consulting, investment banking, sales teams or even truckers,” said Epstein. “It may not be convenient or accessible for them to go to a doctor’s office for every routine visit.”
Health care providers’ reluctance to embrace telemedicine also could hold back its adoption. While telemedicine programs in which individual patients initiate access to a physician through a telehealth service typically compensate providers for each session, physician-to-physician telemedicine does not always come with reimbursement.
Similarly, employees may prefer turning to a trusted primary care physician with health questions. But while more doctors outside of telehealth services are making themselves available by phone, e-mail or video chat, compensation by insurers remains a hurdle.
“Providers have no incentive under current payment models to use telemedicine because they get a reduced fee or no fee for those kinds of services,” said Bakalar.
Joanne Sammer is a New Jersey-based business and financial writer.
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