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Telemedicine: Fulfilling the Promise

Virtually every group health insurance agent and employee benefit professional has encountered telemedicine, as have many human resource professionals. In fact, telemedicine is almost exclusively marketed in conjunction with employee benefits. The argument for including telemedicine is simple: By teaching employees to use telemedicine instead of going to the doctor’s office, urgent care center or emergency room, healthcare claims will be reduced. thus helping the employer get control of his long-term costs. Unfortunately, many of those who have come into contact with telemedicine have been disappointed with the end result.

In talking with benefit professionals that focus on groups of 100 employees or more, there is near universal disappointment in terms of actual utilization. Teledoc said on March 2, 2016, that it had 573,000 visits out of 12.2 million members. While that may sound like a lot of visits, the number only represents a 4.72% utilization rate. In terms of a company with 250 employees, that would mean that 12 employees chose to use telemedicine vs. a face-to-face appointment. How much real savings can be created?

See also: It’s Time to Embrace Telemedicine  

There are two approaches to pricing the telemedicine product in the employee benefit marketplace. The first approach, which is found in most health plans, is to charge the member a copayment of $39 to $49 per visit. Unfortunately, for most employees, any copayment represents an impediment to utilization. The second approach is a fee per member per month. The real value of this approach is that it eliminates the copayment at the point of utilization. In theory, this should increase utilization, but the approach requires continual communication, which is often lacking. One would think that there would be a greater effort to drive utilization by all parties involved, such as the group benefit professional, the human resource leadership and the telemedicine provider, but, alas, that is not the way it is.

Realizing the Promise of an Improved Bottom Line

There are three simple strategies that can have a major impact on an employer’s bottom line.

  1. Increasing utilization of the telemedicine product should reduce the claims paid. For every urgent care visit eliminated, the health plan saves approximately $155 (according to a study in Annals of Internal Medicine), and for every emergency room visit avoided the plan saves an average of $1,300. According to MSNBC: “While it’s true that out-of-pocket costs can be as low as zero for the uninsured or just a small co-pay for insured patients, we know that most emergency room visits really cost an average of $1,233.
  2. Make the telemedicine product available for emergencies. When a member calls virtually all of the current telemedicine providers, the first sound that she hears is a recording stating: “If this is an emergency, please hang-up and dial 9-1-1.” For the average employee, it is easier to hang up and head to the emergency room or urgent care center than make the determination of whether there is an emergency. If the telemedicine program is equipped to engage in medical triage, the program can make the determination and call for the ambulance if needed while staying on the line with the member/patient. This approach would provide two cost saving benefits. First, the member would actually get care quicker than left to her own devices, resulting in lower medical bills per occurrence. Second, the approach would increase utilization of the telemedicine program because employees would not be required to try to determine if the situation is a medical emergency.
  3. Create a telemedicine pathway for workers’ compensation claims as a first step in dealing with an obvious non-emergency for an on-the-job injury. Of course, where there is an obvious medical emergency, calling 9-1-1 directly is the better choice. But for 80% of on-the-job injuries the telemedicine program equipped for medical triage can save the employer hundreds of dollars per occurrence by avoiding emergency rooms and urgent care centers. Equally important is the fact that this immediate response results in an employee’s sense that the employer actually cares, and this improves outcomes.

See also: Triage, Telemedicine Change Work Comp  

These three simple strategies will result in measurable savings for an employer. Beyond the obvious financial savings generated by these three strategies is the less obvious but very real financial gain resulting from increased employee satisfaction with the employer. Providing a good telemedicine program will markedly improve morale and productivity as employees become the recipients of the application of employer empathy. Equally important is the fact that providing a no-copy telemedicine plan helps offset the impact of increased deductibles, coinsurance and copays as well as other cost-shifting strategies for dealing with increased health insurance premiums.

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