Telemedicine Moves into the Mainstream

Just four to five years ago, telemedicine was only recommended to employers who were very large or had a highly rural workforce, according to Cynthia “C.J.” Marks, Area Vice  President and Market Leader at Teladoc.

Today, telemedicine is going mainstream, with consulting firm Towers Watson predicting employers can save $6 billion from its use and projecting a 68 percent increase in employer adoption in 2015.

Marks and Dr. Rich Cassidy, Vice President, Health Services at Teladoc, spoke at The Alliance Learning Circle on The Changing Health Care Consumer on July 16 at Monona Terrace in Madison.

Key Capabilities of Telemedicine to Consider

Marks and Cassidy listed capabilities that employers should consider when selecting a telemedicine vendor.

• How is telemedicine delivered? Available solutions include video conferencing via the Internet; mobile apps; telephone; and solutions that combine those channels.
• What is the cost structure? Some providers combine a small per-employee-per-month (PEPM) fee with an additional fee for each patient who consults with a doctor, which may be paid by the
  employer or charged to the employee or family member. If a fee is charged, it can be collected at the time of the consult using a credit card or PayPal.
• How do patients get an appointment? Marks noted that the ability to start the process by registering over the phone saves time and streamlines the process. As soon as registration is completed, the patient can be placed in a queue to receive a call from a doctor, which typically occurs in less than 10 minutes at Teladoc. It’s also important to allow employees to schedule a
  consult in advance, which attracts shift workers and others on a tight timeframe.
• How are prescriptions handled? The top three telemedicine providers all use e-prescribing to electronically send prescriptions to pharmacies, which is preferred. Teladoc doctors do not prescribe any controlled substances, which helps prevent abuse of prescription narcotics. Generic medications are prescribed for 98 percent of Teladoc patients getting a prescription. Cassidy
  noted that telemedicine providers should monitor prescription rates against Centers for Disease Control guidelines and other best practices.
• Are privacy and security addressed? Telemedicine should work with all electronic health records, comply with Health Insurance Portability and Accountability Act (HIPAA) rules and protect patients’ identities as it shares information with patients and providers in real time.
• Are users satisfied? Employees typically appreciate access to telemedicine, with 95 to 98 percent satisfaction rates. Users’ top complaint is that the doctor refused to prescribe antibiotics.

Challenges for Employers Using Telemedicine

Cassidy highlighted two challenges facing telemedicine services for employers. First, state regulations must be updated to enable consistent use of telemedicine in all states. Phone and video consults with prescriptions are allowed in 45 states, including Wisconsin, Illinois and Iowa; four place some type of additional limitation on how consults are structured; and one state, Arkansas, requires a face-to-face meeting between the patient and doctor before telemedicine may be used. Second, employers must roll out the program in a way that encourages employees and family members to call for care when appropriate. When employers fail to communicate, employees don’t use the service. Getting 2 to 3 percent utilization by employees allows an employer to break even in offering telemedicine. Employers who offer Teladoc to employees for a small fee get 11 percent utilization, which rises to 20 percent when the service is free.

A Better Alternative

Telemedicine’s biggest savings coming from preventing misuse of the emergency room or an urgent care center. Marks noted that 80 percent of patients who use an emergency room are there  because of lack of access to another form of care.

Telemedicine gives these patients a cost-effective alternative, Marks said.

“Telemedicine can be viewed as somewhat disruptive,” she noted. “We want you to ride that wave.”