Telemedicine Explosion Coming to a Health Plan Near You
Telemedicine is not a medical specialty. Defined broadly, it is “the use of medical information exchanged from one site to another via electronic communications to improve a patient’s clinical health status,” says the American Telemedicine Association (ATA). It began as a means of linking patients at small remote medical facilities to more highly trained or specialized physicians in large medical centers.
Today, telemedicine often takes the form of people sitting in front of a computer monitor in a video-based dialog with a doctor. The ATA estimates that last year, 350,000 patients took advantage of telemedicine. But that’s only the beginning. They project that by 2018, that number will rise to roughly seven million.
$1,223 vs. $50
Here’s one attention-grabbing pair of statistics put forth by telemedicine advocates: the average cost of a visit to the emergency room is $1,223 according to one study, compared to the average cost of a physician visit via telemedicine, which is about $50.
Also compare that $50 charge with the average cost of a visit to a primary care doctor, currently around $150. Less dramatic, yes, but that $150 figure does not factor in the frustration of patients who may have to wait days for an appointment, or the risk that during that interval, the condition could worsen.
Either way, the opportunity for cost savings and more prompt care appears to be quite promising, with benefits for patients, employers, physicians and health plans. Some telemedicine providers even offer around-the-clock access, 365 days a year.
Big Health Carriers on Board
The major U.S. health plan providers, including Aetna, United Healthcare, CIGNA, and WellPoint, have already begun incorporating telemedicine options into their offerings within the last couple of years. Aetna predicts that eight million people covered by its various plans will have access to telemedicine next year, up from three million currently.
Nobody is claiming that telemedicine will make direct contact with a doctor obsolete. Far from it. Telemedicine services list the categories of ailments they can diagnose and — where appropriate and permitted by state law — treat with prescription medication.
Teladoc, the self-described “first and oldest telehealth provider in the nation,” lists the following occasions as “good times” to use the service:
- Anytime you need care for “common conditions” including cold and flu symptoms, bronchitis, allergies poison ivy, pink eye, urinary tract infections, respiratory infections, sinus problems ear infections.
- If you’d like your lab results analyzed.
- If you’d like a recommendation for a specialist.
- If you have a health-related question.
- When you’re on vacation, on a business trip, or away from home.
- If you need a short-term prescription refill of common prescriptions.
- If you’d like a medical issue explained to you or you need a second opinion.
- If you’re thinking of going to urgent care or the ER for a non-emergency issue.
Other services often focus more narrowly on simply addressing immediate health issues.
If Not for Telemedicine…
According to Teladoc’s internal research, if patients surveyed had not first connected with their doctors, they would have gone to: an urgent care center (42 percent), their primary care physician (38 percent), the emergency room (8 percent), a specialist (1 percent) or done nothing (11 percent).
Telemedicine customers regularly do need to be redirected to a source of hands-on medical assistance, including the emergency room. But Teladoc claims the average medical cost savings per online consultation is $198, and that doesn’t count preventing lost productivity if the employee were to take time off work for a doctor’s office visit.
Teladoc and other such service providers often contract with health plan companies, and are thus incorporated into their product offerings. They also contract directly with individuals who find it more economical than paying for doctors office visits out of their own pockets until hitting their health plan deductible.
A question that has dogged telemedicine services is whether physicians can diagnose a condition as accurately by a tele-visit as they could in person. Indeed, a handful of state medical associations have restricted telemedicine services for that very reason, from such actions as prescribing drugs. Of course, some say part of the motivation for those restrictions might be the desire to fend off competition for their members.
The American Medical Association has essentially given its blessings to the concept, although in June it issued a set of standards to ensure proper care is provided. One recommendation is that a “patient-physician relationship must be established to ensure proper diagnoses and appropriate follow-up care.”
Incorporating a telemedicine component to your health plan is not necessarily a no-brainer. If your health plan provider offers the service, you’ll need to satisfy yourself that employees ultimately will wind up with quality care — and that they will take advantage of the resource if you make it available.
If providing telemedicine and encouraging employees to use it (for example by offering financial incentives), is viewed by your staff as just a way to cut costs, adding this type of care could be counterproductive. A better approach would be to consider your options carefully, and discuss them with a representative sampling of employees before moving forward. One option to mull over would be to simply subsidize employee access to a telemedicine service for those who choose to sign up.
Of course, a telemedicine service might come automatically as part of an “off-the-shelf” health plan that you have already chosen. Assuming you are satisfied with the quality of care the service provides, your only task would be to encourage employees to give it a try.