During the Pandemic, Telehealth Steps Up

The coronavirus pandemic has changed many things—among them people's willingness to try telehealth services. It also helps that the federal government has, at least during the health crisis, relaxed restrictions that had hindered telehealth use. For instance:

• On March 11, the IRS issued guidance stating that high-deductible health plans can cover telemedicine consultations about COVID-19, the respiratory disease caused by the coronavirus, before enrollees meet their plan deductibles.
  

• On March 18, the president signed the Families First Coronavirus Response Act, which includes a requirement that group health plan insurers cover COVID-19 diagnostic testing, including the cost of telehealth visits used to prescreen for testing, without cost-sharing or prior authorization.
  

• On April 11, federal agencies issued a set of FAQs clarifying that any services offered by a provider through a telehealth visit for COVID-19 diagnostic testing must be covered in full. The guidance encourages group health plan sponsors to promote the use of telehealth services.

Telehealth visits are often used to determine whether an onsite appointment is necessary or desirable for diagnoses and treatment. And while an in-person follow-up may be advised, often, enough information can be shared during a virtual visit to make an office visit unnecessary, such as when a doctor determines that the reported symptoms don't indicate COVID-19 or that the case is not severe enough to require more than recovery at home.

A Surge in Use

As a result of the pandemic, telehealth use has seen exponential growth over the past few months. According to a recent article in The Wall Street Journal, telemedicine providers reported an overwhelming surge in calls beginning in March, when most people throughout the U.S. began living under stay-at-home orders.

"Like many other facets of daily lives, people are choosing virtual meetings instead of face-to-face contact" for safety reasons, said Christopher Calvert, senior vice president at HR consultancy Segal in New York City. "The question is, will the uptick in telehealth continue? That's what we don't know."

Changing Minds

In several important ways, the telehealth marketplace has changed permanently. For instance, many people are having their first experiences with telehealth and will now understand what it is and how it works.

A mid-March survey of 2,000 U.S. adults by information technology firm Sykes Enterprises found that nearly 60 percent of respondents said COVID-19 made them more likely to consider using telehealth services in the future, as well. Telehealth vendors' ability to cement these gains will largely depend on how well these services and their providers perform during the current surge in use.

The survey indicates they are still doubters. Among the skeptics' top concerns regarding telehealth services were:

• Quality of care (41 percent).
• Accuracy of diagnoses (41 percent).
• Privacy of personal and health care data (26 percent).

Convincing one patient of the value of telehealth can greatly influence not only that patient's willingness to schedule virtual medical appointments in the future, but the likelihood that his or her family and peers will schedule virtual appointments, as well. A 2019 survey by market research firm J.D. Power of 8,296 health consumers who used a telehealth service within the past year found that 65 percent of users chose telehealth because of a positive recommendation from someone else. The good word was most often shared by:

• A friend, family member or colleague (22 percent).
• A health plan (21 percent).
• A primary care doctor (20 percent).
• An employer (18 percent).

Other factors also come into play. "The success of telehealth very much depends on the type of workforce involved," said Calvert. "Do [employees] have access to the necessary technology, and are they comfortable using it?"

Assessing Telehealth Performance

Telehealth shows great promise for improving access to health care and managing costs. However, these benefits are not automatic. Employers should be prepared to do some digging to see how well telehealth programs are working.

Employers can track the performance of telehealth services in two ways. Their immediate focus should be on overall use and how well telehealth providers are meeting specific benchmarks, such as how quickly people can get an appointment, patient waiting time after checking in, the number of issues resolved after the first visit, and the number of follow-up visits needed.

At the same time, employers should evaluate how employees are using the service:

• Are employees using telehealth for basic primary care, urgent care or specialist services?
  

• When and where are spikes in service demand happening?
  

• Are employees using telehealth-specific vendors for care, or are they conducting telehealth visits with traditional brick-and-mortar physician practices?

This last metric can have important cost implications for employers. Brick-and-mortar "providers who create telehealth services may be able to bill the same amount for a virtual visit as they do for an in-person visit," said Calvert. "If this type of telehealth becomes more prevalent after the pandemic, employers will need to look at these channels and whether they are the most appropriate site of care."

More in-depth analysis can focus on the impact of telehealth on visits to specialists and hospital emergency rooms. "Assess the cost of those visits, and compare that to a cost of telemedicine consultation to determine savings," said Ed Griese, senior vice president of insurance services at TriNet, a professional employer organization. "While analyzing data, it will be important to separate the routine telemedicine consultation from the consultation during the COVID-19 shutdown."

Andy Ellner, CEO of Firefly Health, said that "many telehealth firms are not offering relationships with doctors. Instead, they tend to be transactional and focused on urgent care." This is where some telehealth providers are looking to make their mark. Firefly Health, for example, is pursuing a relationship-based telehealth model.

Ellner recognizes that the company's success will depend on how well it performs given current demand. As a result, the company is focusing on managing wait times, ensuring a positive customer experience and high satisfaction, and showing how it is helping employers manage costs by avoiding expensive care in emergency rooms and hospitals, especially for chronic conditions such as high blood pressure, depression and diabetes.

"We are focused on providing more traditional care, avoiding wasteful care and improving patients' health," he said.

[SHRM members-only HR Q&A: How does the Families First Coronavirus Response Act impact employers?]

Mental Health Counseling

As many employees feel heightened levels of stress and anxiety due to the pandemic, employers are increasingly using telehealth programs to offer mental health counseling and being more generous with counseling sessions available through employee assistance programs (EAPs).

EAPs, like other benefits, are now app-accessible, allowing participants to interact with counselors online. Telehealth service providers are also offering therapy sessions via phone or videoconferencing with psychologists and other mental health professionals as part of their programs.

"One of the goals of telehealth resources is to remove the barriers of getting help by putting the help right in the palm of someone's hand," and that includes virtual mental health benefits, said Misty Guinn, director of benefits and wellness at Benefitfocus, a cloud-based benefits management platform firm.

Telehealth for Pets

Chris Middleton, senior vice president and general manager of Pets Best, a veterinary insurance provider, also expects to see more demand for virtual veterinary services as a result of the pandemic, in large part due to people's increased use of telehealth for themselves. "I suspect the feeling may be, 'If telehealth/virtual care is good and convenient for me and my family, why not for my pet?' ", he said.

Most states require that pet owners have a pre-existing veterinary client-patient relationship before using virtual appointments, Middleton noted.

Looking Ahead

It is important to get employee input on telehealth, but not until the pandemic has receded and employees feel a return to some level of normalcy, urged Calvert. "In six or eight weeks, employers can gather statistics and feedback on telehealth utilization and performance and encourage employees to keep using it," he said. This is the time to remind employees about what telehealth covers and what to expect from it, and encourage them to use it when they need it.

Joanne Sammer is a New Jersey-based business and financial writer. Stephen Miller, CEBS, contributed to this article.

Related SHRM Articles:

Use of Telehealth to Support FMLA Leave Extended into 2021, SHRM Online, January 2021

Virtual Physical Therapy Could Be Telehealth's Sweet Spot, SHRM Online, November 2019

Telemedicine Improves Health and Saves Money, If Employees Use It, SHRM Online, May 2018

Telehealth Continues Rapid Growth but Regulatory Barriers Persist, SHRM Online Benefits, December 2017

Telemedicine Missteps: Beware HSA Eligibility and Other Compliance Traps, SHRM Online Benefits, June 2017

Related SHRM Resource:

SHRM Vendor Directory: List of Telemedicine Companies