Tag Archives: telemedicine

The Questions to Ask on Telemedicine Risk

A conversation with our insureds often begins with them asking, “Am I covered if…?” As an insurance carrier risk manager, I’m happy that they’re asking (and I’m really happy if it turns out they are asking before starting the business, practice, procedure or service that prompts the question). The question gives us all an opportunity to refocus on applying the risk management process to identify, analyze, treat and then re-evaluate the risk.

Increasingly, these types of questions among healthcare providers are related to some kind of telemedicine service or activity, and they are interesting questions.

The applications for telemedicine are growing exponentially (as is the variety of providers), much as TV and microwaves caught fire decades ago (figuratively, not literally, although hazards are also a domain of risk management). Why the surge in interest?

For starters: healthcare cost containment; an increasing financial incentive; increasing market share; access to specialists and other care providers in rural or other underserved areas; access to healthcare for those who are unable to travel; convenience and time management (both for patients and providers) and continuity of care.

Although “risk avoidance’ is a legitimate risk technique, it can be an easy out and may be a natural reaction to an emerging risk area such as telemedicine. It is critically important that today’s healthcare risk managers not be known as “the just say no people.” As a former clinician, I have seen how cutting-edge approaches to medicine have advanced the state of healthcare. And, telehealth is here to stay!

Let’s get back to the “Am I covered?” question. The short answer would, I hope, be: “Of course you’re covered. Telemedicine is a good thing for patients.” Right?

But, (yes, risk managers like to say “but,” usually after saying, “I don’t want to be negative about this idea, service, procedure, etc.”) a certain road is paved with good intentions, and there are some significant possible risk exposures and obstacles to implementing a safe, compliant and effective telemedicine program. Although risk managers are generally fun people – honest — we can be perceived as wet blankets at times, because we always look at the world through the “risk vs benefit” lens. So, in reality, insurance carrier risk managers may need to say, “It depends. . . .” and then, “I have some questions.” This is where you can help by confidently putting your best foot forward and saying, “Ask away, I have the answers you need.”

A risk manager’s job (yours and mine), first and foremost, is to protect the assets of the organization. And that protection certainly includes helping to appropriately support and defend good clinical care and those who provide it, especially when someone registers a complaint or pursues a professional liability claim. We need to not only look at specific professional liability insurance policy language, but we must also consider all of the risks and exposures associated with telemedicine and determine whether you are adequately treating those risks. Insurance coverage is just one of the risk treatment techniques (risk transfer) used to address risk exposures – even though it can feel like the most important one to those who are kept awake at night worrying about an organization’s risk exposures, liability and finances.

In today’s complex healthcare environment, there is a need for an operational (enterprise) risk management approach to decision making to help manage liability exposure across all of the domains of risk. Along with that, the role of the healthcare risk manager is evolving into taking a leadership role in this approach. But developing a culture and discipline of identifying, analyzing and treating risks is more of a journey than a sprint, so try not to get daunted by the process right away. You can be more “tactical” (a rapid response) as the circumstances may require once you establish process.

An Example

Let’s take an example of one risk exposure for a telemedicine program — credentialing and privileging — and illustrate how we can help answer the “Am I covered…” question by using the risk management process (the first three steps anyway; I’ll leave the “monitor/re-evaluate” steps to you).

Risk Identification

What do we already know about some of the key risk exposures related to telemedicine? We recognize that they generally may include the following, but you’ll need to also identify any other risks unique to your program:

  • Information privacy/data security
  • Potential technology-related issues (e.g., failure, resolution, accuracy, etc.)
  • Data ownership/retention/destruction/e-discovery
  • Credentialing/privileging of providers
  • Patient selection, communication, education
  • Documentation of communication and encounters
  • Consent for use of technology/treatment
  • Health insurance payer coverage/reimbursement
  • Billing
  • Compliance
  • Contracts/agreements
  • Liability insurance coverage

Analyzing the Risk

Here’s a series of questions that I’d like to know the answers to as your carrier in evaluating you as a “risk.” You should have done your due diligence already. The sample list is not meant to be exhaustive, but illustrates developing a discipline around a comprehensive analysis:

  • Does your governing body understand its role and responsibilities regarding credentialing and privileging? (Standards of care, scope of practice, negligent credentialing, non-delegable duty, D&O, E&O, etc.) Even when a third-party credentialing verifications organization is used, privileging decisions are still the responsibility of the hospital’s governing body.
  • Are you a hospital telemedicine site? A free-standing telemedicine site? An originating site or distant site? Is there a solid understanding about how telemedicine credentialing and privileging should be done depending on your role?
  • Have you met all applicable state statutory requirements for a telemedicine license? How about applicable state medical/licensure board requirements for all licensed practitioners? Non-licensed? What are the exceptions to requirements?
  • Have you met all accreditation standards and requirements (if applicable)?
  • Are there written policies and procedures in place that outline the credentialing and privileging appointment and reappointment processes, criteria for telemedicine activities, scope of practice protocols, OPPE and FPPE and the data from the originating and distant sites that must be collected and analyzed (and acted on)? How will the originating site be notified of privilege or license revocations or suspensions?
  • Do your hospital or medical staff bylaws and rules and regulations accurately reflect these issues for telemedicine: federal regulatory and state specific licensure requirements (for all providers); current CMS CoPs; health insurer panel requirements for credentialing; the privileged provider’s medical staff category?
  • Does the current structure of your quality-improvement and peer review programs adequately protect shared data between originating and distant sites?
  • Is there a compliance plan that addresses billing practices and regulatory noncompliance?
  • Are there written agreements in place between the distant site hospital or entity and the hospital seeking services?
  • Do you have the appropriate medical staff leadership and medical staff services resources to manage your credentialing and privileging activities?
  • Are there appropriate, required governing body, medical staff leadership and medical staff services training and education on credentialing and privileging for telemedicine?

Analyzing Insurance Coverage

By way of this next series of questions, you can begin to bring into focus some possible strategies for treating telemedicine risk exposures by using the risk transfer technique to ensure you have the right coverage for those risks:

  • Will existing health professional liability (HPL) coverage address errors and omissions on the part of distant-site physicians and practitioners?
  • Do you have adequate coverage limits for the telemedicine activities and providers?
  • Are there subcontractors allowed? If so, confirm the subcontractor’s insurance coverage and limits.
  • Are there shared or individual coverage limits? Which should be required to meet your risk financing needs?
  • Are there any jurisdictional limits for coverage under the policy? State-to-state provider licensure?
  • Are there practitioners practicing outside of the U.S.? Do you have any exposure in countries outside of the U.S.? Will (HPL) coverage extend to such services?
  • Is your insurance carrier licensed to write coverage in multiple states? Foreign countries?
  • What types of insurance coverage are in place for negligent credentialing, where claims are based on reliance on credentialing and privileging information submitted by a distant-site hospital or distant-site telemedicine entity?
  • Does the hospital have appropriate coverage for business disruption (the third-party vendor stops offering the service)?
  • Are insurance coverages (at limits set in medical staff bylaws approved by the governing body) in place for credentialing and privileging legal exposures:
    • Does the telemedicine provider have professional liability coverage for this service?
    • Does the telemedicine provider have cyber risk coverage?
    • Does your cyber risk/technology E&O coverage extend to the telemedicine activities?
    • What types of insurance coverages and limits will be required by contract of the distant-site hospital and distant-site telemedicine entities?
    • Will the contract preclude shared coverage among the (ever-changing) list of care providers and the distant-site hospital or distant-site telemedicine entity?
    • Will the insurance coverage include indemnification coverage for cost of defense up to the point of disposition of a regulatory investigation based on the telemedicine services furnished by the distant-site hospital or distant-site telemedicine entity?
  • Review of your insurance coverages should extend to the various layers of an insurance program – excess carriers – and also to specialty programs such as RRGs, insurance trusts and captive insurance plans.

In Summary

How can you develop a discipline of comprehensive risk identification, analysis, treatment and evaluation to address risks such as telemedicine credentialing? Here are some key steps in the process to consider:

  • First, create or gather your “Operational/ERM Committee” (or whatever you wish to call it). There should be a core group for this, and then perhaps create ad hoc “tactical taskforces” for each specific issue as necessary. In the case of telemedicine, this may mean consulting with internal and external resources such as legal , insurance carrier, risk managers, medical staff, medical staff services, marketing, finance, regulatory, accreditation, quality, compliance and IT professionals.
  • Gather data and input. As a side note, this is an area where some insurance carriers provide valuable tools and resources for their clients to use; for example, OBPI has a web-based Telemedicine Risk Assessment Tool that will efficiently perform a “risk inventory” to help in your data gathering and risk identification. So be sure to tap into that expertise.
  • Create/document your “risk inventory” (include all of the domains of risk).
  • Perform your risk “gap analysis.” Where are your weaknesses or gaps?
  • Determine your risk evaluation (for each weakness/gap determine the domains affected and the degree of impact to the organization).
  • Decide how you wish to treat each risk exposure (the proposed risk treatment technique and proposed action plan). Develop or revise your written operational plans, policies and procedures and credentialing and privileging services agreements as necessary.
  • Talk to your producer/agent to determine what type of coverage, at what limits of liability, are best for your organization.
  • Put your requirements for coverage in your organization bylaws or medical staff bylaws.
  • Monitor, measure (develop dashboards/scorecards), re-evaluate and re-design as necessary.

In the End

To circle back to the initial question, “Am I covered?”, as you can see, the answer may not be a simple, immediate “yes.” “It depends” is what you may be more likely to hear. But despair not.

Remember, we’re all risk managers, in this together, trying to protect the assets of the organization by treating risk exposures adequately and effectively. Be prepared to present your ERM analysis and treatment results in response to questions (or, even better, preemptively present them when you ask the question about insurance coverage), and you’ll be on your way to an answer that is hopefully more like, “Of course you’re covered. Your telemedicine program is a good thing,” than, “Houston, we have a problem.”

And, you, your carrier and your broker can all breathe a sigh of relief and get a good night’s sleep.

How Health Tech Is Changing Work Comp

The passage of the Affordable Care Act (ACA) changed both the dialogue and dynamics of healthcare in this country. It has also brought employers a new set of challenges and opportunities.

Seemingly uncontrollable medical costs have plagued virtually all businesses in recent decades. The medical component of claim costs now accounts for well over half of the total workers’ compensation cost make-up.

In addition, as more individuals have signed up for coverage under the ACA legislation, the demand on the system for healthcare services is becoming increasingly strained. This demand, coupled with a projected shortage of physicians, has made access to care a more prominent workers’ compensation concern.

The offshoot of such pressures and constraints is a strong and unyielding focus on healthcare technology developments and advancements. The rapidity with which such innovations are being made, and the advances planned in the healthcare treatment and delivery landscape in the coming years, are phenomenal. Undoubtedly, technology will play an increasingly important role in maintaining employees’ well-being and fostering their recovery in the future.

Some of the technological advancements that are available today and on the verge of exploding onto the healthcare scene include telemedicine, Google Glass, wearable monitoring devices, Internet-connected sensors, 3D printing and robotic devices. These are designed to increase the efficiencies associated with delivering healthcare and maximize the providers’ time and talents.

Below are some additional details on these innovations and the advantages they can bring to the workers’ compensation industry.

The American Telemedicine Association defines telehealth as remote healthcare technology designed to deliver clinical services. This could include alternatives ranging from medical providers consulting patients by phone to performing robotic surgery from a remote location. Telemedicine can certainly benefit injured or ill employees in situations such as nurse triaging and clinical consultation. For example, using telehealth, a nurse at a remote location can evaluate symptoms and determine whether an injured employee needs to be seen directly or can be discharged with instructions for homecare. Telehealth can also be used to reduce or even eliminate wait times and thus, appointment costs. A patient visiting an occupational healthcare provider who needs an evaluation from an orthopedist could have it right on the spot via a conference call during which the test results are projected onto a screen visible to the specialist.

Google Glass
Google Glass technology is being used today to maximize the time and talents of specialty providers and bring high-level expertise to remote areas of the country. One of its most valuable applications is in surgery. For example, a surgeon in New York could assist a surgical team in rural Oregon and show them precisely where to make an incision for a given procedure. Google Glass can also increase a physician’s efficiency in seeing and assessing patient conditions. A patient’s electronic health records could be displayed on Google Glass as a physician is conducting an initial assessment. Information such as medical history or current symptoms and medications could be reviewed in real-time as the physician converses with the patient and determines ensuing treatment. Moreover, in coming years, patients may use Google Glass to assess and evaluate physicians based on available information and reviews appearing on their own display.

Wearable monitoring devices
A number of wearable healthcare monitoring devices have flooded the market and have become popular among a select set of consumers. They are frequently worn around the wrist and can monitor physical information, such as calories burned, steps taken, activity, blood pressure, heart rate, sleep patterns and other defined metrics. These devices help increase awareness among users. For example, if a morning run is missed and step count is down, the individual may be more inclined to take the stairs, park farther away from the building or consume fewer calories. The next step is for users to begin sharing this information with their medical providers as a way of becoming more engaged healthcare consumers. Such information would allow a physician to customize a healthcare treatment plan specifically for that individual as opposed to relying on more general treatment guidelines.

Internet-connected sensors 
Sensors are being used and will become more readily available in the future as a way of monitoring and communicating an individual’s condition. For example, an individual who has recently undergone surgery may have sensors in his shoes to send an alert if he becomes unstable, thereby increasing the risk of a fall. Such sensors may trigger an alert to a smartphone, dashboard or other monitoring device signaling that the individual needs assistance. With the additional capabilities of these devices, resources can be deployed where and when needed, allowing for more effective and efficient care.

3D printing
3D printing is perhaps one of the most fascinating and promising medical advancements. Using 3D printing, experts have produced replicas of human hearts, which allow surgeons to perform a procedure in advance of an actual operation, improving quality and outcomes. 3D printing is also being used to produce human skin. This technology can be a tremendous benefit to burn victims and can reduce recovery time considerably. It also shows promise in aiding back surgeries. Previously, titanium plates were inserted between disks, and bone would grow around these plates. 3D printing allows the production of cellular structures that can become part of the bone growth itself. Such advancements are expected to reduce the need for repeat surgeries.

Robotic devices
Robotic devices are being used now and will likely become more common. One of their current uses is to help extend the efficiency and effectiveness of nurses and allow them to focus more specifically on patient needs and priorities. For example, when a nurse is recording vital signs, a robot can be used to retrieve supplies, allowing the nurse to spend more time providing valuable patient care. Looking further into the future, robots may be used to provide more extended patient care.

These types of medical technology advancements are helping to create a culture of connected health that will redefine our treatment and delivery system. While new challenges and risks will arise, technology will play a prominent role in tomorrow’s healthcare. In the not-too-distant future, the amount of real-time information and communication that can be shared instantaneously is hard to imagine. This will allow for more productive and cost-effective interactions among patients, providers, employers, payers and caretakers. A more effective and efficient healthcare system characterized by improved quality and outcomes is a win-win situation for virtually all workers’ compensation stakeholders, and one that could quickly become a reality in today’s world.

Preparation breeds optimism, and employers have the opportunity to prepare for the roll-out of the new healthcare legislation using digital health advancements. The suite of health technology tools, companies offering solutions in this space and the advanced products described above are all part of the newly evolving digital health arena, and undoubtedly these advancements will be part of a broader solution.

In looking ahead, the convergence of digital health solutions with evolving healthcare delivery models has the potential to significantly improve access to care, address quality concerns and assist with costs. This would enable consumers to become more engaged and active in their health and, in turn, lead to improved health and productivity for employers. This would be a workers’ compensation offshoot by which we could all stand.

This article first appeared at WorkCompWire.

Workers’ Comp Issues to Watch in 2015

Tis the season for reflections on the past and predictions for the future. As we kick off 2015, here are my thoughts on the workers’ compensation issues to watch this year.

What Does TRIA’s Non-Renewal Mean for Workers’ Compensation?

Thanks to congressional inaction, a last-minute rewrite added this subject to the issues for this year. I’m not about to predict what Congress will do with TRIA legislation in 2015, as there are no sure things in the legislative process. We have already seen the reaction from the marketplace. Back in February 2014, carriers started issuing policies that contemplated coverage without the TRIA backstops. We saw some carriers pull back from certain geographic locations, and we also saw some carriers change the terms of their policies and only bind coverage through the end of the year, giving themselves the flexibility to renegotiate terms or terminate coverage if TRIA wasn’t renewed. But while some carriers pulled back in certain locations, others stepped up to take their place. While some carriers tied their policy expiration to the expiration of TRIA, other carriers did not.  Going forward, some employers may see fewer carrier choices and higher prices without the TRIA backstop, but ultimately most employers will still be able to obtain workers’ compensation coverage in the private marketplace. Those that cannot will have to turn to the State Fund or assigned risk pool.

Rising Generic Drug Prices

The opioid epidemic, physician dispensing and the increased use of compound drugs are issues the industry has faced for years. While these issues continue to be a problem, I want to focus on something that is getting less attention. Have you noticed that the costs for generic prescription drugs are increasing, sometimes significantly? In the past, the focus was on substituting generic drugs for brand names, which provided the same therapeutic benefit at a fraction of the costs.  But now the rising costs of these generic medications will drive costs in 2015. These price increases are being investigated by the Federal Drug Administration (FDA) and Congress, but I do not expect this trend to change soon.

Medical Treatment Guidelines

Another issue to watch on the medical side is the continued development of medical treatment guidelines and drug formularies in states around the country. This is a very positive trend and one that our industry should be pushing for. There is no reason that the same diagnosis under workers’ comp should result in more treatment and longer disability than the same condition under group health. One troubling issue that I see here is the politics that come into play. Sorry, but I do not accept that human anatomy is different in California or Florida than in other states. I feel the focus should be on adopting universally accepted treatment guidelines, such as Official Disability Guidelines, or “ODG,” rather than trying to develop state-specific guides. The ODG have been developed by leading experts and are updated frequently. State-based guidelines often are influenced by politics instead of evidence-based medicine, and they are usually not updated in a timely manner.

How Advances in Medical Treatment Can Increase Workers’ Comp Costs

There is one area in which advances in medicine are actually having an adverse impact on workers’ compensation costs, and that is in the area of catastrophic injury claims. Specifically, I’m referring to things such as brain injuries, spinal cord injuries and severe burns. Back in 1995, Christopher Reeve suffered a spinal cord injury that left him a quadriplegic. He received the best care money could buy from experts around the world, and he died less than 10 years after his injury.  But as medicine advances, we are now seeing that a quadriplegic can live close to normal life expectancy if complications can be avoided. Injuries that used to be fatal are now survivable. That’s great news. The downside for those paying the bills is that surviving these injuries is very costly. The cost of catastrophic medical claims used to top off around $5 million, with a $10 million claim being a rarity. Now, that $10 million price tag is becoming more the norm.

The Evolving Healthcare Model

For years, workers’ comp medical networks focused on two things: discount and penetration.  Sign up as many physicians as you can as long as they will agree to accept a discount below fee schedule for their services. I’m happy to say that we are slowly, finally, evolving away from that model. Payers are realizing that a better medical outcome for the injured worker results in lower overall workers’ compensation costs, even if that means paying a little more on a per-visit basis. We are now seeing larger employers developing outcome-based networks, not only for workers’ compensation, but for their group health, as well. Employers are also starting to embrace less traditional approaches such as telemedicine. Finally, more and more employers are recognizing the importance that mental health plays in the overall wellness of their workforce. In the end, we are slowly starting to see is a wellness revolution.

The Need for Integrated Disability Management

The evolving healthcare model is tied directly to an evolving viewpoint on disability management. More employers are realizing the importance of managing all disability, not just that associated with workers’ compensation claims. Employees are a valued asset to the company, and their absence, for any reason, decreases productivity and increases costs. I feel this integrated disability management model is the future of claims administration. Employers who retain risk on the workers’ comp side usually do the same thing with non-occupational disability. These employers are looking for third-party administrators (TPAs) that can manage their integrated disability management programs. And make no mistake: Having an integrated disability management program is essential for employers. Human resource issues such as the Americans With Disabilities Act (ADA) and the Family and Medical Leave Act (FMLA) cross over into the workers’ compensation realm. The same interactive process required on non-occupational disability is required in workers’ compensation. Employers must be consistent with how they handle any type of disability management, regardless of whether the cause is a workers’ compensation injury or non-occupational.

Will We See a Push for ‘Opt Out’ in Other States?

Most people know that non-subscription, or opt out, has been allowed in Texas for many years. The Oklahoma Option that started last year is viewed as a much more exportable version of opt out. Under this system, employers can opt out of workers’ compensation, but they must replace it with a benefit plan that provides the same (or better) benefits available under traditional workers’ compensation. While some view the Oklahoma Option as the start of an opt-out revolution, it is just too early to tell what impact it will ultimately have. But, make no mistake, discussions about opting out are spreading to other states. A group called the Association for Responsible Alternatives to Workers’ Compensation is currently investigating the possibility of bringing opt out to other states. I expect to see opt-out legislation in a handful of other states in the next three to five years.


Marijuana legislation is a very hot topic these days.  In national polls, the majority of Americans favors legalization of marijuana in some form.  Recreational use of marijuana is now legal in four states (Colorado, Washington, Oregon and Alaska), and 23 states allow medical marijuana. When it comes to workers’ compensation, much of the attention has been focused on medical marijuana as a treatment option for workers’ comp because a judge in New Mexico allowed this last year. My concern is around employment practices. Employment policies around marijuana have been centered on the fact that it is illegal, so any trace in the system is unacceptable. That is going to change. I fully expect the government to reclassify marijuana from Schedule I to Schedule II in the next few years. When that happens, zero-tolerance policies in the workplace will no longer be valid. Instead, the focus will have to be like it currently is with alcohol: whether the person is impaired.

The Next Pandemic

Another hot topic these days is Ebola. While the threat from this particular disease seems to be subsiding, the concerns about Ebola last year showed we are not ready for that next pandemic. People who were exposed to the disease were allowed to interact with the general population and even use commercial travel. Government agencies debated whether travel to certain countries should be limited. The problem is, diseases don’t wait for a bureaucracy to make decisions. While this threat didn’t materialize, you can see how easily it could have. With work forces that travel around the globe, the threat of a global pandemic is very real. You know where you send your workers as part of their job, but do you know where they go on vacation? As an employer, are you allowed to ask about what employees do during their personal time? Are you allowed to quarantine an employee who traveled to an infected country during vacation? These are very complex legal questions that I cannot answer, but these are discussions we need to be having. How do we protect our employees from the next pandemic?

Rates and Market Cycle

You cannot have a discussion around issues to watch without talking about insurance premium rates in workers’ compensation. After several years of increasing rates around the country, the National Council on Compensation Insurance (NCCI) is projecting that, in 2014, workers’ compensation combined ratios were below 100% for the first time since 2006. This means that, as an industry, writing workers’ compensation is profitable again. So what should buyers expect in 2015? Well, it depends. California continues to be a very challenging state for workers’ compensation costs. New York is challenging, as well. Given the percentage of the U.S. workforce in those two states, they have significant influence on the entire industry. Some employers will see rate reductions this year, and some will not. In the end, your individual loss experiences will determine what happens with your premiums. That seems to be the one constant when it comes to pricing. Employers with favorable loss experiences get lower rates, so it pays to stay diligent in the areas of loss prevention and claims management.

Will We See More Constitutional Challenges Similar to Padgett in Florida?

While I don’t think the Padgett case will be upheld on appeal, I am concerned that the case is the first of many similar ones we could see around the country. Look at the main arguments in Padgett: The workers’ compensation system is a grand bargain between injured workers and employers. Workers gave up their constitutional right to sue in civil courts in exchange for statutorily guaranteed, no-fault benefits. Over the last 20 years, many workers’ comp reform efforts around the country have focused on lowering employer costs. Standards of compensability have been tightened. Caps have been put on benefits. The judge in Padgett looked at these law changes and ruled that workers’ compensation benefits in Florida had been eroded to the point where it was no longer a grand bargain for injured workers. He ruled that the workers’ compensation statutes were unconstitutional on their merits because the benefits provided are no longer an adequate replacement for the right to sue in civil court that that the workers gave up. Attorneys tend to mimic what succeeds in other courts, so I expect we are going to be seeing more constitutional arguments in the future.

Impact of the Evolving Workforce

One of the biggest issues I see affecting workers’ compensation in 2015 and beyond is the evolving workforce. This takes many forms. First, we are seeing technology replace workers more and more. When was the last time you went to a bank instead of an ATM? I have seen both fast food and sit-down restaurants using ordering kiosks. Also, we are seeing more use of part-time vs. full-time workers. Some of this is driven by concerns around the Affordable Care Act. But part-time workers also have fewer human resource issues, and their use allows employers to easily vary their workforce based on business needs. Unfortunately, part-time workers are also less-trained, which could lead to higher injury frequency. Finally, the mobile work force is also creating concerns around workers’ compensation. Where is the line between work and personal life when you are using a company cell phone, tablet or computer to check e-mails any place, any time? Where do you draw the line for someone who works from home regularly? There have been numerous court cases around the nation trying to determine where that line is. This is a very complex and evolving issue.

To view a webinar that goes into these topics in more detail, click here: https://www.safetynational.com/webinars.html

Care Transparency – What Employers Are Missing!

Employers are trying hard to reduce health care costs and create a healthier, more-productive workforce. They have tried to optimize employee usage of services offered by their health plans and invested in wellness programs. They are now beginning to consider (or have implemented) cost transparency tools and second opinion and telemedicine services.

All these approaches are right!

What employers are missing is an understanding of how employees are making health care decisions and how that impacts their health care costs.

A large population of health care consumers are starting with a search engine to find health care information online. In the past year, 72% of U.S internet users have gone online specifically for health related information, and 77% of them begin their research at a search engine.1

And age has nothing to do with it!

Of those who seek health information online, 73% are 50 years of age or older.

At the same time, many doctors are urging patients to not rely so much on Google for health research. Doctors lament that they often have to correct misinformation or incorrect conclusions after patients do health research online.2

Even when employees go to a reputable site such as WebMD or a health plan’s member portal, they end up with a laundry list of treatment options. Try running a search for back pain — you will end up with more than two dozen treatment options. Health care consumers don’t know what is effective, appropriate or necessary, so most follow recommendations from friends or family or go through trial and error based on what they read online. Here are a few treatment decisions for back pain:

  • Buy a heating pad
  • Buy a muscle relaxant
  • Buy over-the-counter drugs
  • Go to the chiropractor (the one Uncle Bob recommended)
  • Go get massage therapy
  • Do yoga
  • Go to a doctor
  • Go to an orthopedic specialist (because your friend swears by it)

You get the point.

Each wrong treatment decision costs employers money — $235 per treatment decision, to be specific.3

Multiply that by the number of employees in your organization (and their dependents) and number of treatment decisions they make.

This is a huge avoidable cost.

Phone consultation services such as care/disease management or health advocacy are not going to stop employees from going online for help. It doesn’t make sense for employees to be calling someone every time they have a question regarding their health issues.

Employers also need to meet employees where they are — online. Employers need to provide them with tools that can help their research and decision making process with robust, accurate, unbiased and evidence-based information.

Employers can help create care transparency by offering Treatment Selection and Shared Decision Support tools. Employers can significantly improve the quality of care consumed by their employees and reduce health care costs by focusing on creating care transparency.

In my next article, I will write about the types of tools that will be effective in supporting employee decisions and the type of tools that employees will really use in making care/treatment decisions.


1 77 Percent Of Online Health Seekers Start At Search Engines [Pew Study]

2 Doctors Warn Against Relying Too Much On Google

3 WiserTogether, Inc research