Troubleshooting Telemedicine

telehealthThe healthcare landscape is changing as providers increasingly offer virtual care options, and naturally it’s taken some getting used to. A recent study by the Deloitte Center for Health Solutions found that while patients who have used virtual care reported a 77% satisfaction rate, only 44% felt that their wait time was reduced compared to an in-person office visit. Some offices are designating doctors for virtual care on specific days of the week to circumvent wait times caused by healthcare professionals bouncing between in-person and virtual patients.


4 factors driving adoption of telehealth

This article was published on October 8, 2018 on BenefitsPro, written by Dan Cook.


Photo source: BenefitsPro

Five years ago, when talk turned to telemedicine or telehealth, the word “potential” either preceded or closely followed the discussion. In 2018, that potential is finally being realized.

You don’t need to look further than a physician’s office, a benefits consultant’s option packages, or the details of a major employer-sponsored health plan. From online consultations to take-home self-diagnostic kits to remote specialist networks, telemedicine is suddenly everywhere.

The National Business Group on Health, which represents major employers, has charted the growing adoption of telemedicine by its members. Today, 96 percent offer some type of telemedicine benefit as part of their health plan, compared to 46 percent in 2015. NBGH’s 2019 Health Care Survey confirmed the shift. “The adoption of telehealth among large employers has been made nearly ubiquitous due to health plans offering telehealth to all its members,” NBGH said.

Yes, engagement numbers are still fairly low. Generally, less than 10 percent of employees had a telehealth visit last year, the NBGH survey reported. But driving that engagement upward is among the NBGH’s 2019 priorities.

The group’s vice president for public policy, Steve Wojcik, says telemedicine is here to stay. “With large employers, adoption is growing pretty rapidly. The large employers view it as a value add for their plan. They believe it will reduce costs over time. They just need to make sure their employees understand that it is a benefit and one that can improve their lives.”

Wojcik and others interviewed for this article pointed to four key factors that have unleashed telemedicine’s potential: convenience, demonstrated time and cost savings, greater acceptance by younger workers, and acceptance by the health care brokerage community.

Other factors have contributed, among them improved user experience. Even the smoothest functioning and most effective telehealth tools will defy engagement if they are not well designed from an accessibility standpoint. But here are the big four that are unleashing the long-simmering potential of telemedicine.

Convenience: It has to be easy

For patients to accept any changes in the way they receive health care, convenience has been shown to be a key to utilization. Avoiding the clinic’s waiting room is a powerful incentive for an employee to test drive an employer plan’s telehealth visit with a physician. Fitbits have paved the way for a flood of products that deliver non-invasive, real-time collection of an increasing range of health data that allow clinicians to get a much more complete picture of one’s health.

And employer onsite clinics have taken telehealth convenience to a new level. Astute employers are integrating telemedicine into the onsite clinic to leverage the high levels of employee engagement. Services such as First Stop Health can connect the onsite primary care physician with a nationwide network of medical specialists who can provide same-day, and sometimes same-hour, diagnoses for conditions and symptoms that are outside the PCP’s expertise. Simply put, the telemedicine industry is focused on convenience—and it’s working.

The convenience factor of many telehealth products has opened up new areas for addressing employee health. Increasingly, the NBGH found, employers are using telehealth to meet multiple health needs: “A trend of note is the growing interest in telebehavioral health, or mental/behavior health services made available through phone or video consultations.”

Demonstrated time and cost savings: Money (saving) talks

Time is money, and employers understand the link between telemedicine/telehealth and the amount they spend on employee health. If telehealth is convenient, employees will use it. The more they use it, the more these three outcomes can be measured:

  • Time saved by telehealth visits that replace trips to the clinic;
  • Reduced absenteeism due to improved health outcomes;
  • Reduced claims due to improved health outcomes.

A fourth outcome, increased productivity, remains difficult to pin down. In theory, a healthier workforce should be a more productive one. But to prove the connection between telehealth and productivity, employers need more experience and more data.

The telemedicine industry knows that it must demonstrate to employers both greater employee engagement and cost savings over time. Patrick Spain, CEO of First Stop Health, a telehealth network of medical providers, says the first wave of telehealth devices and services failed to take into account the employer’s need to reduce cost as well as to see workforce health improvements. The result: participation barely hit 5 percent.

“We think the payers, like Amazon and Berkshire Hathaway, are the most important part of the equation. We think about how we can create a better experience at a lower cost for our patient and member, and then how does that stream back to the client?”

First Stop Health offers employer plans a nationwide network of medical professionals to whom plan members have immediate access when a health concern arises. In a few short years, utilization among employees has topped 50 percent—six times the average telehealth participation rate NBGH found in its 2018 study.

Spain says a key was working with employers to promote the plan. “They offered [telehealth] benefits before, but as a copay, and without any promotion. We insist that employers help us educate employees, and we won’t charge a copay or anything else.”

Today, few large employers question the value of a telemedicine component to their plan. According to a 2016 Mercer employer health survey, “Offering telemedicine services has quickly become the norm: 59 percent of all large employers offer these services, up from just 30 percent [in 2015]. Savings for members can be significant, especially before the deductible is met, as a typical charge for a telemedicine visit is $40, compared to $125 for an office visit.”

Greater acceptance by younger workers: Millennialism strikes again

No doubt, millennials are the most surveyed, studied and profiled generation that has ever lived. Researchers and pundits broadly attribute any number of characteristics to the simple fact that someone was born between the early 1980s and the mid-1990s to early 2000s. Research on adoption of new technology clearly shows that millennials lead the way, and that love of technology has translated into a ready adoption of telehealth products and services.

“Younger employees are used to getting everything through their phones,” Wojcik says. “They want to access their health care through the same device.”

Because they now represent the largest generational slice of the workforce, millennials are rapidly driving expansion of employer plan telemedicine. Led by the millennials’ enthusiasm for telehealth, older employees are following suit. And of course, Generation Z, soon to assert itself in the workplace, is perhaps even more at ease with technology that the millennials.

Noting the results of the 2017 survey by the Employee Benefit Research Institute (EBRI)/Greenwald & Associates, The Robert T. Waters Center for Telehealth and e-Health Law remarked: “The results of [the survey] are shedding light on something else about millennials: they love telemedicine … Younger health care consumers are happier to receive care in non-traditional health care settings, including via telemedicine and in walk-in clinics, than their older peers.”

Brokerage community acceptance: “I can’t sell low engagement”

In general, health insurance brokers have approached telemedicine and telehealth benefits gingerly. They would often rather just sell insurance policies and standard benefits; but that’s changing.

For years, telehealth benefit engagement numbers were extremely low. And while they remain modest, according to the NBGH survey, they are improving. Some options are reporting employee participation in the 50 percent to 60 percent range, numbers unimaginable just a few years ago.

Insurance brokers are overcoming their telemedicine benefits reservations as more clients demand such products and services. “We are seeing increasing interest from brokers and employee benefits consulting firms,” says Anu Nadkarni, vice president, Payer Solutions, Tyto Care, which provides a telehealth solution for performing comprehensive at-home physical exams and diagnoses. “They see this as a game changer to utilize telehealth benefits. They’re looking at new opportunities, asking themselves, ‘Where can we improve the member experience?’”

The problem hasn’t been with the products or services, says Rachel Miner of Thrive Benefits. Neither brokers nor employers have been effective at selling telehealth benefits to employees. “Telemedicine has to be a benefit that people see as a benefit,” she says. “Part of it is making sure people will use it.” If the benefit offers convenience, saves time, and is easy to use, employees will engage. But first, brokers and employers have to do a better job of communicating the benefits. “For a broker to offer these services, you need to have strong utilization and have it work for the client. You have to be able to say, ‘Here’s the ROI.’ And we are finally seeing that.”

One product she likes is the HealthJoy concierge app.

Here’s how HealthJoy describes itself: “The platform brings together medical professionals, advocates, Rx savings, an artificial intelligence-powered virtual assistant, and more into an easy-to-use app that employees love.”

Here’s how it works for Miner’s trucking company client: A driver is on the road, far from his or her home health-care turf, when a sudden medical concern flares. The driver simply opens the HealthJoy app, places a call to be connected with a doctor to discuss the condition, and is quickly connected with a medical professional who can start the diagnosis and treatment process on the phone.

“You can show the ROI there,” Miner says. “Think of the savings for a trucking company client. And what if you can just call a doctor on the road and they will send the prescription to where you are? That’s a benefit that works.”

States Moving Forward on Telemental Health

telehealthStates are moving toward telemedicine to help students access mental health services. Minnesota and Utah have proposed telemental services in order to reach students with underserved mental health needs. Students with unmet mental health needs experience many obstacles, with conditions such as depression and anxiety negatively impacting their attendance and performance.

Telemental health is being utilized to reach those in areas without child therapists or in other “healthcare deserts”. Texas has successfully implemented telemental health programs since 2012, connecting thousands of students with much needed care and treatment. One proposed Minnesota bill suggests launching four telemedicine projects aimed at improving access to telemental health services for students. Proposed grants would help provide dedicated space in schools and the technology needed for students to access telemental health services. A bill in Utah would enable the Division of Substance Abuse and Mental Health to create a two-year program using a telemedicine platform to facilitate remote consults between children and child psychiatrists.

Legislators and school officials in a number of states see many benefits to pursuing a telemental health platform, including the potential to identify young people contemplating suicidal or homicidal actions.


Getting People to Use Telemedicine


24/7 physician access by phone or video has the potential to do great things for health plans and consumers. Getting a doctor’s help without waiting in a medical office is a great convenience, especially if you’re traveling or your primary care physician is unavailable. The challenge, however, is that telemedicine does not sell itself – it needs to be communicated over and over again if we want members to remember they have this great, easy-to-use benefit instead of driving to an urgent care center. Technology is great, but it won’t activate itself. People are creatures of habit and it takes a good deal of effort to change behavior. Low tech tactics like email reminders, flyers or refrigerator magnets may just be what the doctor ordered when trying to drive home the benefits of telemedicine.


Help Pass the HSA Improvement Act

United States Capitol Building

On March 1, Representatives Mike Kelly (R-PA) and Earl Blumenauer (D-OR) introduced H.R. 5138, the Bipartisan HSA Improvement Act. The legislation includes several provisions NAHU has advocated in recent years to address issues with HSAs and employer-sponsored coverage.

The legislation seeks to promote flexibility, encourage innovation and expand access to HSAs by aligning HSA regulations with the most effective cost-containment strategies that will help consumers save money and stay healthy.

Specifically, the legislation would:

  • allow HSA plans to offer pre-deductible coverage of health services at onsite employee clinics and retail health clinics.
  • allow HSA plans to offer pre-deductible coverage for services and medication that manage chronic conditions.
  • permit the use of HSA dollars toward wellness benefits, including exercise and other expenses associated with physical activity.
  • clarify that employers can offer “excepted benefits” like telehealth and second-opinion services to employees with a HSA plan.
  • correct the definition of “dependents,” streamline FSA conversion and fix the prohibition on a spouse using a HSA.

Contact your representative today! NAHU is calling on all members to send an Operation Shout asking your member of Congress to support H.R. 5138. You can also call your state representative.

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Empowering Employees: Big Talk, Little Action

dg-empoweringTelemedicine offers a lot of potential for everyone – added convenience for busy families and lower costs than a traditional office visit. But as helpful as this service can be, it will only make a difference if it is used.

Low utilization is not unique to telemedicine. It’s a common problem with many new, well designed and well-intended health care services. Encouraging plan members to actually use new offerings is a challenge for employer groups, large and small. And while utilization is often higher in self-funded health plans, all employers need help turning talk into action. Here are a few ideas to consider:

It’s all about them – With health care consuming more of everyone’s income and attention, we all have a vested interest in our benefits. And while wonderful tools like telemedicine keep coming to the table, you need to look at these offerings from your member’s perspective rather than your own. Talk with your employees; ask if a service will help them and listen to their feedback. If it can add real value to your employee’s lives, utilization will follow.

Talk about health, not cost – Research indicates that when it comes to their health and well-being, there are many things members would prefer to hear about than fees and costs. A majority are interested in improving their health. It takes time, but focusing on current health risks and personalizing communications as much as possible will help members want to get more engaged.

Educate to empower – Transparency tools and online portals are no different than other modern advances. If people don’t understand them, they will never catch on. Like telemedicine, unless employees understand how to use it and when they can use it, they will never realize the benefit of having an experienced, board certified physician, with access to their medical records, available to help them 24/7.

While it seems that other new disruptive innovations, such as Alexa, catch fire overnight, they do take time. Since your employee communication budget likely pales in comparison to those driving consumers to Amazon, talk with your TPA about new ways to zero in on the needs of your employees. Doing so can lead to increased utilization and a happier, healthier workforce in 2018 and beyond.


Strong Growth Forecast for Telemedicine

This article was published on January 15, 2018 on HealthLeaders Media, written by John Commins.


Telemedicine has been a hot topic in healthcare for some time. And, while plenty of content has discussed its potential of added convenience and lower costs, plenty of other content has pointed out its low utilization. It’s true that most people are not pursuing the consumer-like behaviors that telemedicine can offer, such as video doctor visits via mobile device or prescription drug cost comparison tools. However, the article included below recently discussed the strides that Teladoc, a telemedicine provider, made in 2017, leading some in the industry to expect fast growth within the telemedicine space.

At Diversified Group, we believe strongly in telemedicine and we offer telemedicine solutions. We work closely with our clients to help them zero in on the needs of their employees and explore possible cost control measures, such as telemedicine. Please read the full article below.

The industry is riding sustained tailwinds that will push growth 30% to more than 40% in coming years. Factors include a growing dearth of clinicians, an aging population, and technological innovations that will improve patient access and experience.

If Teladoc, Inc. is a bellwether for the telemedicine industry, the outlook is bright.

Jason Gorevic, CEO of the Purchase, NY-based telemedicine provider, called 2017 “a landmark year as we redefined the virtual care delivery landscape with our acquisition of Best Doctors.”

“Through rapid integration, Teladoc has brought to market innovation that gives members a single point of access for a wide array of medical needs. We are seeing a tremendous reception from both clients and prospects to this unique, comprehensive solution,” he said.

Preliminary numbers provided by Teladoc support Gorevic’s claims. According to unaudited 2017 financial results, the company saw:

  • Total revenues of $232 million, an 88% increase over 2016
  • Total membership of 23 million, a 31% increase over 2016
  • Total visits of 1.46 million, a 53% increase over 2016, and representing utilization of 7%, compared to 6% utilization in 2016.

Teladoc finished 2017 on an upswing, with unaudited fourth quarter results showing:

  • Total revenues of $76 million, a 103% increase over 2016
  • Total adjusted EBITDA of $2.5 million compared to a loss of $8 million in the fourth quarter 2016
  • Total visits of 460,000, a 48% increase over 2016, and representing utilization of 2%, compared to 1.8% utilization during the same period in 2016

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