Tag Archives: telemedicine

Benefit Advisers Must Actually Advise

Sales is the name of the game, no matter the industry, but some professions should focus more on providing sound advice and less on promoting new and trendy products. Many benefit brokers fall into that latter category, and I say this as someone who has been in the insurance industry for 25 years.

It used to be that group insurance brokers were more transactional. Get a good product at a fair price, provide some service, and your client is generally happy. Today, that same broker must create compliance initiatives, administer COBRA, FMLA, enrollment services, ERISA advice and some human resource functions. This new responsibility requires expertise beyond what’s needed to get an insurance brokers license, yet, like most entrepreneurs, we adapt. We must, however, get back to basics.

As group benefits brokers, we must turn our attention to the core mission of our profession today. That mission is strategic consultation and education for our clients, addressing the cost of providing healthcare in this country. It is, by far, the biggest driver of the increase in the cost of, and inability to afford, group health insurance.

Certainly, maintaining an awareness of professional trends has its benefits, and often a new offering can make a big difference for clients, but advisers need to dial down the reseller role and concentrate on imparting guidance to address core issues.

Next to payroll, the largest expense for most businesses is the cost of group health insurance. Yet many benefits advisers continue to go down the same old path by providing information on the same, tired, cost-shifting plans – this despite the fact that these plans’s premiums are rising faster than the cost of living.

See also: Benefits Advisers: It’s About to Get Real  

Benefit brokers need to begin educating clients on what is really driving premiums. One significant lesson that should be learned upfront is that joining a large insurance purchasing group is rarely the solution for small to medium-sized businesses, because savings are short-term for most. The dominant problem facing health insurance prices is the cost of providing care. It won’t cost less for a small firm with a staff of 10 for an MRI or maternity stay simply because it is in a pool of 5,000 employees. Although these multi-employer plans may show short-term savings, unless there is a marked improvement in the risk pool, as with every other group collective purchasing arrangement for healthcare, it fails. And, oftentimes these plans are dangerous self-insured arrangements where the employer, and sometimes even the broker, has little knowledge of the potential risk.

The need, from my standpoint, is for businesses to embrace measures that can result in less prohibitive healthcare costs, beginning with the use of telemedicine programs not owned by insurance companies. An eye-opening statistic from the American Medical Association indicates that over 70% of all emergency room, urgent care and primary care visits could be handled via telemedicine. This is a cost-effective alternative that will reduce the employers claims cost by a weighted average of $240 to $300 per visit. Offering telemedicine as a benefit not only decreases claims and keeps overall costs down, but the employees are less likely to miss work due to a medical appointment.

An independent second opinion program is another avenue to trim costs, yet a mere 19% of health care consumers get second opinions. This is head-shaking as a study conducted in 2014 by the Houston Veteran Medical Center and the Baylor College of Medicine estimated that 12 million people in this country are misdiagnosed annually. The study went on to show a change in diagnosis by nearly 15%, as a result of a second opinion and as high as 26%. The course of treatment is changed an astonishing 70% of the time. An independent medical second opinion program can provide simplified access to high-profile medical centers/teaching hospitals, specialists, etc. in collaboration with a patient’s attending physician team, often for little to no cost. Result: Employees are less likely to miss work due to a misdiagnosis or follow-up appointments. Consider, also, that the third leading cause of death in the U.S. is medical errors.

Offering employees a choice as to how they purchase prescription medications is another cost-efficient employer healthcare program. It fosters consumerism by deploying a comparative prescription drug environment and can lower cost for the consumer and the employer, sometimes substantially. Numerous online prescription drug programs can help members identify discounts, coupons and subsidies available for their high-tier prescriptions. Current and emerging technologies aggregate these programs so immediate access to potentially less expensive prescriptions drugs are identified and easily obtained by the patient. Also, some of these programs will have deductible and copayment assistance programs designed to keep people compliant with their medication regiments. Another easy way to reduce costs.

Employers need to weigh the worth of group health insurance against self-funding; if choosing the latter, always offer a reference-based pricing option. This plan recognizes that insurance company payments to hospitals can be as much as 300% to 600% more than what Medicare would pay. Reference-based pricing plans might pay the hospital just 50% over Medicare. If an employer or local market isn’t ready for this aggressive approach, there is a solid opportunity to educate about reference-based pricing.

See also: Reinventing Sales: Shifting Channels 

Those of us in the insurance and benefits industry have the responsibility to shed light on strategies that address the real drivers of cost rather than simply regurgitating what we are told are current industry trends.

3 Techs to Personalize Claims Processing

Claims is a people business – virtually every claims executive I have ever met believes this. If you have ever been in a vehicle accident, experienced damage to your home or business, or been injured in a work-related incident, one of the first things that comes to mind is: I need to talk to someone who can assure me that I have insurance coverage and that there will be resources, both financial and technical, to make me whole again. This reaction is a human one and is not likely to go away. Many claims organizations have tried to maintain staffing levels to ensure a human connection is available to all. However, this is expensive, and claims organizations are already experiencing a shortage of individuals to fill critical claims roles.

Claims executives are at a crossroads, and many questions arise. How do we maintain 1:1 people interactions and simultaneously manage skills gaps and expenses? Then there are digital expectations from all parties to the claim – insureds, claimants, distributors, service providers – how are those expectations met? Given all these weighty challenges, many claims decision-makers relate to the phrase: “There’s a light at the end of the tunnel, and it’s a train coming the other way.” But, for many claims organizations, the reality is that the digital train that is coming can provide answers to the people challenges they face.

See also: How Work Culture Affects Claims Process  

SMA’s recent research report, Claims Transformation: New Paths Forward for Reporting,  Verification and Communications, explores emerging technologies and trends in claims operations. Relative to the people business theme, there are several areas of innovation where concerns, expectations and answers merge.

  • Self-reporting via photo and video. Apps that facilitate the insured or claimant in providing visual representation of damage will speed the claim along versus waiting for an adjustor or inspector to do the same thing. Faster settlement clearly meets consumer expectations. Additionally, precious claims resources are preserved for more complex claims.
  • Self-reported photos and videos along with AI analysis. The resulting outcomes from AI analysis can facilitate the next-generation of straight through processing (STP), ultimately going well past the current glass and towing claims STP, as things such as machine learning evolve over time. Again, shorter time to settlement with little or no claims adjustor involvement – a win-win.
  • Telemedicine and digital health platforms blend consumer-accessed, personalized information with a collaborative environment for adjustors, service providers, medical professionals and other concerned parties. These technologies blend useful, self-service information with human access at the moment of need.

These are just a few examples of the technologies that claims organizations have at their disposal to transform processes and operations. The previously mentioned SMA research report covers many other areas.

Make no mistake, balancing when to insert adjustors into processes and when technology can facilitate desired outcomes is not easy to accomplish. One of the key success factors is to look at claims processes from the outside in. This is not intuitive for claims organizations that have spent entire careers managing the challenges and intricacies of the adjustment process with an internal lens to meet corporate compliance goals and tangential department needs within a regulatory framework that can be daunting.  However, looking at claims processes from the consumer perspective – outside in – can suggest ways of execution that fulfill the need for the customer to be compensated for their loss in the fastest way possible or to find the clearest path to wellness. Happily, these outcomes also preserve human claims resources for when an individual really needs it.

See also: The Best Workers’ Comp Claims Teams  

The technology vs. human paradigm will continue to change, probably forever. However, claims is one of the areas within insurance where expert adjustor skills can truly make a meaningful difference for individual outcomes. But the definitions will continue to change, and the challenge for claims executives will be to continually assess processes through a different lens. Optimistically, the light in the tunnel will be a source of inspiration.

How Telehealth Changes Senior Care

Many baby boomers would be willing to give virtual healthcare a try, but they want to be sure that an e-visit or other type of remote care is just as good as the care they would get in person. They also want to be confident that their health information stays private.

For seniors who live in rural areas with few doctors, telemedicine would improve their access to healthcare and be more convenient. For many people with chronic illnesses or mobility issues, making it to the doctor’s office can be an ordeal. With telehealth, they can have the doctor visit virtually.

What Is Telehealth

Telehealth is a collection of methods for enhancing healthcare, public health and health education delivery and support by using telecommunication technology. Today, telehealth covers four domains of applications. Each state and insurance company varies in its use and reimbursement of these applications. They are commonly known as:

  • Live Video Conferencing (Synchronous): This is a live, two-way interaction between a person and a provider by using audiovisual telecommunications technology. The Center for Connected Health Policy made a micro-documentary video, “Telehealth Saves Lives,” that shows how video telehealth can be a lifesaving technology.
  • Store-and-Forward (Asynchronous): This will allow recorded health history to be transmitted through an electronic communication system to a practitioner, usually a specialist, who uses the data to evaluate the case or render a service outside of a real-time or live interaction. This technology will allow access to specialty care, even when there are limited board-certified specialists in the community.
  • Remote Patient Monitoring (RPM): With RPM, patients will be able to transmit their personal health and medical data from one location to a provider in a different location via electronic communication technologies for use in care and related support. “Telehealth and Quality of Care” is another video from The Center for Connected Health Policy that demonstrates how remote patient monitoring can help individuals stay healthy in their home.
  • Mobile Health (mHealth): This is the healthcare and public health practice and education supported by mobile communication devices like, tablets computers, cell phones and iPads. Applications can range from text messages that encourage healthy choices to large-scale alerts about disease outbreaks.

Telehealth encompasses a variety of technologies and tactics that deliver virtual medical, health, and education services. Telehealth is a collection of means to enhance care and health education, not a specific service.

What Will Telehealth Do for Seniors?

The older we get, the more health issues that arise. Therefore, seniors are more likely to experience chronic conditions, such as diabetes and heart disease. Both illnesses require routine monitoring from healthcare providers.

With telehealth technology, doctors can now keep an eye on things such as blood pressure and sugar levels. Routine doctor’s visits can be costly and difficult for seniors to attend, especially if the elderly person has mobility problems or limited access to transportation.

The use of telehealth can improve communication between providers and patients, allowing physicians to monitor an older patient’s overall health. This level of monitoring can allow providers to discern when patients may be becoming sick or at risk of experiencing a medical emergency.

While seniors are at a higher risk for developing chronic conditions that require care provided by specialists, specialists are not always located in every community, and travel is often warranted. This can be difficult for seniors.

Telehealth removes the barriers of location and mobility, connecting more seniors with necessary care provided by specialists. Telehealth also makes it easier for family members who live far away to stay connected to their elders’ care program. This will relieve some of the stress associated with caring for seniors.

See also: Navigating Telehealth for HR and Employers  

When telemedicine is used, caregivers have greater access to providers. These providers can give them information that helps provide more effective care. Without a need for routine in-person visits to providers, caregivers can dedicate more time to care at home or in their own personal and professional lives.

Not only is telehealth more practical for routine monitoring and time efficiency, it is a more cost-effective option for both patients and providers.

  • Telehealth has the potential to make physicians more money, because telehealth allows for less time-consuming individual consultations, meaning the doctor has time to see more patients each day.
  • Telehealth means big savings for patients, because consultations delivered virtually usually cost less, and money is saved when travel is eliminated.

When nursing homes adopt telehealth technologies, up to $327 million can be saved each year through a reduction in the need for emergency room visits. Telehealth is a life saver and a money saver.

Medicare and Telehealth

Medicare tightly restricts what it will pay for, so seniors have a harder time getting telehealth covered. Some private insurance companies are increasingly covering certain services like virtual visits.

Luckily for Medicare recipients, Congress passed a law last winter that expands Medicare coverage for options such as video visits to diagnose stroke symptoms or check on home dialysis patients.

Medicare Part B would cover the cost of telemedicine services, but the patient needs to fulfill certain conditions.

Medicare Advantage programs are used by a third of beneficiaries and can start offering additional telehealth options. This is a step in the right direction, but it certainly doesn’t cover everything.

Costs are already a major issue for people who need continuing assistance, and telehealth is still new. For telehealth to save the most money, it will need to replace in-person care, not add to it.

More than half of adults of all ages would be comfortable with a video doctors visit via FaceTime or Skype to discuss medications, treatment for continuing care of a chronic illness or even for an urgent health concern.

High-risk patients who use daily telehealth monitoring are less likely to be readmitted to the hospital. This isn’t about just having Skype in the home; it’s about having a team of healthcare professionals who are supporting the care of a patient.

See also: Whiff of Market-Based Healthcare Change?  

The Security of Telehealth

The privacy and security of protected health information (PHI) is very important to insurance companies, doctors and patients. With new technology, usually, comes new challenges. With every problem comes a solution, and by making smart choices patient data can be protected.

Telehealth services are legally required to abide by Health Insurance Portability and Accountability Act (HIPAA) mandates. HIPAA is concerned with the protection of patient medical records, always improving privacy and reducing fraud.

To be sure the health data is safe, your telehealth system should comply with the HIPAA guidelines. To comply, you will need:

  • Business Associate Agreement (BAA): This is a written contract between a covered entity and a business associate that establishes the permitted uses and disclosures.
  • Transport Encryption: This must-have encryption for data security converts the sensitive information into a meaningless stream of seemingly random data.
  • Storage Encryption for the Videos Stored in a Device: This will encode backed-up and archived data on storage media.
  • Properly Stored Data: You have many options here like a flash drive or a cloud storage; in any case, make sure you choose a HIPAA-compliant product or service.

Telehealth can be a secure way to receive medical care and reduce further stress for seniors and caregivers. Telemedicine care is the future of healthcare. Telehealth will save money, time and patients’ lives.

Navigating Telehealth for HR and Employers

It’s no secret that telemedicine delivers faster, more accessible and more affordable medical care for patients across the world. However, when integrating a new telehealth program into your business, there are some details that employers should not overlook.

Let’s start with state regulations. Because they vary across the country, it’s important that employers be aware of the specific compliance regulations issued by their state. If an employer is in compliance with these state regs, the chosen telehealth provider will then help navigate the onboarding process and provide concierge support throughout the duration of the program.

Telehealth and Workers’ Compensation

Another important factor to take into account is workers’ compensation. While telehealth and workers’ compensation have existed for years singularly, thanks to the rapid evolution of technology they have recently come together under the same vertical. To ensure that they’re getting the specific advantages that their business needs, employers should educate themselves on the available options for integrating telehealth into workers’ compensation.

See also: Consumer-Friendly Healthcare Model  

One option for integrating telehealth into workers’ compensation is to make it available to treat acute conditions. It could be particularly useful for employees with minor injuries or those who would rather seek self-care over in-person treatment.

Making telehealth available in cases where a clinic might not be immediately available is another option. In these cases, an employee might be at a remote location and may not have prompt access to healthcare. Telemedicine solves this dilemma by bringing the doctor to the patient. And should injured employees require further care, telemedicine providers will refer them to specialists or ancillary services within their network for continuity of care.

Telehealth is the ideal platform to deliver healthcare to injured employees if they meet the screening process. While all serious cases, emergency or otherwise, should be addressed in person by a physician or at an emergency room, there are far more minor cases that can be safely treated via telemedicine.

The Big Telehealth Picture

Many telehealth programs offer several direct benefits to the injured employee and the employer alike, including 24/7/365 availability, increased productivity, reduced absenteeism, greater employee satisfaction and reduced unnecessary visits to urgent care facilities, which incidentally allows for further cost saving.

Whichever telehealth program employers choose, it’s a good idea for them to make sure they have a strong communications plan to stay educated on benefits, onboarding and more. This often comes in the form of onsite education seminars where employers and employees have direct access to the extended boutique health and wellness services.

See also: Case for Reimbursing for Telemedicine  

And, of course, as with all healthcare benefits programs, it’s equally important to research the benefits, platform features and plan options available in any potential telemedicine services you subscribe to, as no two telehealth programs are exactly the same.

How Telemedicine, AI Are Transforming Care

Dr. David Dantes, a retired ER doctor in his 70s, still manages to work six hours a day starting at 6:30 am and sees about 20 patients per day. His lifetime of medical experience would be ending if he hadn’t joined a telemedicine platform earlier this year. Meanwhile, after a long day of flu-season patients, Dr. Linda Anegawa also uses a telemedicine system to talk to three more patients who couldn’t meet in person. As a doctor on a virtual platform, she’s been able to build amazing trust with many patients who keep coming back for her.

Both Dr. Dantes and Dr. Anegawa are Stanford-trained physicians who believe in providing quality care and convenience to patients. Primary care is often not accessible for seniors and busy patients, and a visit to the ER can be traumatic and expensive. Telemedicine can solve these pain points by bringing care to patients wherever they are and whenever they need it, while smoothing out the logistics of scheduling and traveling, so doctors can focus on their top priority of delivering care. Similarly, health AI holds the promise of increasing efficiency in the care process for improved care outcomes and better time management.

Telemedicine – Bringing Top Quality Care to Patients Conveniently and Efficiently

Telemedicine is not new. There are a large number of companies including Teledoc and other well-funded private companies such as American Well, MDLive and Doctor on Demand that offer telemedicine solutions. Many of the hurdles facing these companies are related to lack of focus on physician quality and low utilization due to patient education, and rolling out services through employer insurance programs doesn’t help. Multiple research and studies have shown that only two out of every five consumers have heard of telemedicine. Utilization rate is even lower at less than 5% across the industry and less than 2% in many companies.

If telemedicine truly delivers on the promise of bringing quality care and convenience to patients, why are adoption rates so low? This past summer, I conducted a survey with 561 participants across the U.S. and found that although 95% of respondents have never used telemedicine, 57% are interested in trying if key concerns could be addressed. Topping the concerns is the quality of physicians, which suggests that telemedicine providers with high-quality physician networks are much better positioned to have high adoption and utilization rates.

PlushCare (GGV portfolio company), the telemedicine platform where both Dr. Dantes and Dr. Anegawa operate, has addressed this issue by building a physician network that only includes doctors from the top 50 medical schools in the U.S. This patient-centric approach with an emphasis on physician quality is seeing a dramatic uptick in both adoption and repeat visits.

See also: Telemedicine: Fulfilling the Promise  

Now that we’ve outlined the needs and primary adoption barrier of consumers, let’s look at what motivates doctors to use telemedicine, because ultimately doctors are the key to the quality of the service. Beyond the scheduling flexibility, companies like PlushCare also offer a suite of tools to help doctors operate more efficiently — from handling the back-end administrative work to streamlining the front-end patient visits — so doctors can focus on what they do best and enjoy doing the most, delivering care to patients. That’s why we see physicians like Dr. Dantes bringing his years of experience back to practice through telemedicine, and others like Dr. Anegawa taking online patient visits beyond her practice.

A common misperception about telemedicine is that the primary target audience is either those who live in rural/underserved areas, or millennials who seem to do everything online. In reality, telemedicine has much broader applications for consumers beyond these groups. Most telemedicine users fall in the age of 35 to 45, with busy work and travel schedules and families with multiple kids. Telemedicine can provide a hassle-free way of seeing a doctor with a lot of flexibility in time and location.

The use cases can even be extended to schools, which are often understaffed with onsite medical professionals, or nursing homes when the seniors have acute symptoms. Instead of sending the patients to ER or waiting for a family member, telemedicine can address many of the problems within 10 to 20 minutes and involve family in the discussion in a three-way call. Most importantly, the convenience doesn’t need to come at the cost of quality.

AI – Doctor’s Silver Bullet to Boost Productivity and Improve Outcome

While telemedicine drives the much needed efficiency to healthcare by simplifying logistics around the care process, health AI targets the care process directly to increase productivity. At the current stage, health AI may not be able to displace doctors and originate treatment plans independently, but it’s more than ready to help doctors allocate time more efficiently depending on individual patient needs, and keep tabs on patients post-visit to improve outcomes and lower readmission rates.

For example, start-up company Lemonaid Health provides a “traffic light” system using an AI model developed by physicians to do the first round of screening on patient cases. Cases are categorized into three pipelines upon screening: “Green,” or straightforward, cases account for 80%; “yellow,” or complex, cases account for 15%; and “red,” or extreme, cases account for the remaining 5%. This categorization allows doctors to spend less time on straightforward cases and focus on patients with more complex situations.

Another example is Carbon Health, which leverages AI to examine and triage patient cases pre-visit through a chatbot interface. Based on the complexity of the cases, Carbon’s AI assistant books an appropriate amount of time for the visit and shares the pre-visit synopsis with the doctor so he or she can dive right into the problem during the visit. The AI assistant also follows up with patients post-visit to keep track of key indicators and resurface cases to the doctor when anomalies are detected.

See also: It’s Time to Embrace Telemedicine  

I am excited to see consumer-centric digital health companies that are providing broader access and better quality of care, and bringing efficiency to the process. Consumers are increasingly engaged in issues about their health and are expecting healthcare tech improvements. Meanwhile, tech innovators are continuously disrupting the status quo. I believe consumers are at the forefront of these changes, and innovators behind consumer-centric digital health companies can win big in this market.

If you are a healthcare founder making solutions to transform consumer experience, I’d love to talk to you.