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Telemedicine | California Corporate Benefits

Telemedicine in Context

As an employer, you are keenly aware that rising healthcare costs are increasingly chipping away at your bottom line — often forcing you to pass on the extra financial burdens onto your employees. This can result in lowered morale.

There is an exciting new alternative, however, to this ever worsening predicament. Telemedicine, which harnesses the power of computers, the internet and telecommunications, is a viable and rapidly developing healthcare strategy which allows healthcare professionals to “see” and treat their patients remotely. It offers a reduced cost solution to runaway healthcare expenditures.

If telemedicine is implemented correctly, it offers extraordinary benefits to employers who embrace it.  We can help make your strategic implementation of telemedicine a solid success. 

We invite you to join us in taking a leadership role in implementing proven measures that can deliver results quickly.  

Benefits for Employees

Employees are happier when they have telemedicine for many reasons

  • $0 Copay, cost-free health care for most common conditions
  • Unlimited use
  • For entire family
  • Service in English and Spanish and translation for hundreds of languages
  • Reduces time off from work for medical visits
  • Quality care
  • Eliminates transportation costs and transportation challenges
  • Avoid waiting rooms full of sick people
  • Convenience
  • Network coverage in all states
  • Fully addresses the most common medical needs (92% of issues resolved after first visit)
  • Increases employee satisfaction (Documented 95% member satisfaction)

After years of bearing increasing health costs such as raising copays, deductibles and coinsurance, many employees regard a $0 copay option is a breath of fresh air. 

In fact in one study 64% of respondents said they delayed care because they didn’t want to pay the high deductible 1.

The Kaiser Family Foundation’s 2009 study found similar results

There is no doubt.  People with high deductibles and copayments delay seeking care, sometimes dangerously.  There is a strong probability that this affects overall health and increases health costs.

It’s the right thing to do.  A $0 copay benefit for diagnosis and treatment by a board-certified, U.S. doctor within 15 minutes can do much to help employees feeling the financial stress of today’s health care costs. (In the busiest month of the year the median waiting time to speak with a doctor was 10 minutes.)

Patients can speak to a doctor in English or Spanish.  Also, translation services are included within minutes for hundreds of other languages.

Telemedicine is not intended to replace your Primary Care Physician or your health insurance plan.  There are, however, no restrictions on the number of visits provided.  Coverage is always for all family members whether or not dependents are covered under the employer’s health plan. 

Since care is so prompt and convenient, telemedicine can also help employees conserve their precious sick days and help reduce or prevent loss of pay caused by taking time off from work for medical office visits.

Employees who wait until after work hours to seek care often end up at urgent care or the emergency room.  Not only are costs high, but most people would rather not have to waste their time sitting for hours in a waiting room full of sick people coughing and sneezing. 

Telemedicine provides quality care.  The American Medical Association (AMA) stated in its annual meeting in June 2014 that it believes using telemedicine to deliver care to patients could greatly improve access and quality of care, while maintaining patient safety. 

Telemedicine avoids transportation costs and transportation challenges.  Some employees may not own reliable personal transportation.  These employees may use ride sharing services like Uber or public transportation or are dependent on friends or family for transportation.  For them, transportation is an additional cost and challenge.  For others, telemedicine allows us to avoid driving, traffic, parking and the loss of time that goes with it.  UC Davis performed a study evaluating interactive video visits for more than 19,000 patients.  The avoided loss of wages was unknown but they found that patients saved:

  • Nearly 9 years of travel time (4 hours each)
  • 5 million miles (263 miles each)
  • $3 million in costs ($158 each)

For some, it’s not about the money.  Telemedicine’s convenience is welcomed.  One of our own employees was having difficulty scheduling an appointment for what she thought was Pink Eye.  She couldn’t get in to her PCP for this highly contagious condition.  She called her Telemedicine provider and within 15 minutes she was speaking with a doctor.  She was able to pick up her prescription within 30 minutes on her way home from work. 

Other employees have written, “This is a Godsend, thank you so much for this new program.  It saved our vacation.  The children got sick and we were considering just returning home.”  

Benefits for Employer’s

Telemedicine can make happier employees.  Happy employees are better workers.

  • $0 cost telemedicine is a recruiting tool
  • Telemedicine is a retention tool
  • Can be a low-cost benefit for part-time employees
  • Reduces absences from work for medical consultations
  • Earlier treatment can reduce the spread of infectious disease
  • Can positively influence health care renewal premiums
  • $517 average savings per Teladoc visit based on a peer-reviewed third party survey
  • Experience reports provide important information on value

Everyone knows that employers have had to manage their healthcare costs by shifting cost to employees.  That has been effective but it has also placed serious financial stress on employees.  A zero-cost healthcare option should be part of every recruiting discussion when explaining your employee benefits to prospective employees.  Many may have been wishing for just such a benefit.  It’s almost unique.  Few other employers offer it.

We don’t have empirical data yet with respect to telemedicine’s effect on retention.  But, unsurprisingly, the link between health insurance and recruiting and retention is strong. More than 45 percent of employees told Towers Watson that their company’s health benefits were an important reason they decided to work there, and 55 percent say these benefits are an important reason they stay with that company.

What’s more, improving health insurance offerings is the easiest way to raise employee satisfaction. According to another Glassdoor survey, increasing employees’ satisfaction with their health insurance by one star (out of five) is associated with a 0.34-star increase in average satisfaction with the company. That’s a higher increase than those associated with retirement plans, vacation, employee discounts and maternity or paternity leave.

While earlier treatment can reduce the spread of infectious diseases among employees, it can be more critical for certain employers who potentially impact public health. 

Finally, high utilization can reduce carrier claims experience, thereby reducing your claim experience upon which your renewal premiums are calculated.

Telemedicine reduces emergency room use.  One telemedicine company performed a claims analysis from 2010 through 2012 for a 13,000 employee group and looked at the number of avoidable emergency room claims over this period.  In comparison to 2010 (pre-Telemedicine), the client has seen an average 16.5% reduction in avoidable ER claims during 2011 and 2012.

Approximately 8% of telemedicine visits are for conditions serious enough that a referral to the patient’s PCP, specialist, urgent care or emergency room must be made.  The potential savings is still significant as the treating physician can triage the patient to the most appropriate setting based on the urgency or seriousness of the condition. 

In addition to cost savings by directing care to an appropriate, but lower cost setting, telemedicine has shown that the number of follow up visits have been reduced by half.

About HMOs or plans that are not experience rated

In southern California HMOs dominate health plan designs because they have been relatively successful in controlling costs and maintaining quality when compared with other structures such as PPOs and Consumer-Directed Health Plans (CDHPs). 

No matter the size of your enrollment, a significant part of your HMO’s cost is fixed in the form of capitation payments.  These are per member per month fixed payments to providers to cover the cost of providing the contracted benefits.  The capitation amounts are generally contracted globally and are not influenced by the utilization of any particular participating employer.  Typically capitation accounts for 70% to 75% of premium. 

It follows, naturally, that in an HMO plan environment less of the cost savings generated by telemedicine will be passed along to the employer in the renewal calculation.  Most HMO plans do track utilization and report it when membership exceeds 250 employees.  Underwriters, who are developing your renewal rates, do review this information.  When your broker approaches your underwriter, your improved utilization is a factor in determining what discounts can be negotiated for your renewal.  In other words, telemedicine can directly impact part of your renewal calculation and influence underwriter discretion on the balance.

A common practice in the industry is for carriers to stratify their mid-market business (groups from 100 to 250 or 300 covered employees) into tiers or pools based upon utilization.  For example, there may be a normal renewal pool of employers, a preferred pool which earns a lower than normal increase, a high utilization pool at a higher than average increase and even an outlier pool.  The pool you qualify for will definitely be influenced by utilization. 

Expenses such as emergency room visits, hospitalization, surgery and prescriptions are examples of expenses that are not capitated.  Telemedicine can influence these costs.  Emergency room utilization has been well explained.  Earlier care can potentially reduce hospital admissions for some acute conditions such as acute asthma and pneumonia.     

About the future

We are in a fast changing world.  Trends in motion tend to stay in motion for a very long time.  One of these trends is toward self-funding.  The compelling attraction to self-funding for employers is to reward employers fully for their efforts in controlling costs.  At some point, an experience-rated plan, a modified self-funding plan or a self-funded plan may be in your future.  The time to begin preparing for that day is now.  

Keys to Success

$0 Copay is the Key to Success

  • Zero cost is one of the most powerful motivations to quickly garner widespread adoption
  • Effective and consistent promotion maximizes utilization
  • Education is important. Once employees understand the benefits they will become your most effective promoters

An increasing number of insurance carriers are introducing telemedicine into their standard benefit plans.  Yet utilization industrywide among insurance carriers is only 1%.  Typically these carriers charge standard PCP office visit copays or discount their copays slightly.  In other words, no financial incentive or a low financial incentive results in almost no change in behavior.    “Free”, on the other hand is a powerful motivator.

High participation is essential if the plan is to be successful.   Regular promotion is needed because telemedicine has not yet made its name for a majority of consumers – in a survey by HealthMine of 500 consumers, 39% have not heard of telemedicine. 4

Participation can be increased significantly with consistent promotion.  Space should be dedicated in your open enrollment book  to highlight this new benefit.  Online enrollment systems can be programmed to promote telemedicine benefits as well.  Monthly or bimonthly communications should be used to remind employees throughout the year about the benefits.  This could be, for example, messages targeted to allergies in the spring and cold and flu season in the winter.  Email, posters and video are all available for use.

Our own experience is that, with our promotion efforts, new plans achieve an average 31% participation within one year and this number is rising.  We find that once employees are using the plan they promote it to their co-workers. Our own utilization rate on average nationwide is presently 40% and climbing.  The overall the national telemedicine utilization rate is only 7%. 5         

Quality Care

Although we offer other telemedicine options, our recommendation continues to be TelaDoc.

  • Physicians average 20 years practice experience
  • All visits are performed by physicians, licensed in their respective states
  • All physicians are board-certified in Internal Medicine, Family Practice, Emergency Medicine or Pediatrics
  • All physicians are U.S. residents, living and working in the United States
  • Verified through the National Practitioner Data Bank (NPDB) and the American Medical Association (AMA)
  • The first and still the ONLY telehealth company in the U.S. to have their provider credentialing process certified by NCQA.
  • Credentialing, rigorous QA, maintenance of evidence-based protocols, adherence to 125+ proprietary telehealth guidelines
  • Teladoc’s physician portal ensures that physicians assigned to consults fully review the member’s Medical History Disclosure (MHD) form, and properly documents the consultation utilizing SOAP notes.
  • For physicians new to Teladoc’s network, 100% of consult charts are reviewed for the first 3 months or the first 10 consults.
  • At least 1 consult chart is reviewed for each physician who performs a consult in any month. Any physician who performs 10 consultations in any month has 15% of consult charts reviewed.
  • A focused audit is performed if there is a patient or physician complaint associated with any consult.
  • In the most recent month, more than 1,500 charts were reviewed to:
    • Ensure that physicians are appropriately prescribing medications based on specific conditions and established guidelines
    • Frequency of specific medications is monitored and continuously compared against industry average statistics and guidelines
    • Ensure that appropriate advice is given specific to patient conditions
  • 96% physician satisfaction rate, zero malpractice claims and ISO27002 and HIPAA compliant

This can make a meaningful difference for employees and their employers.  Telehealth services will play an increasingly important role in delivery of care.  In the study below more than 1/3 of visits occurred on weekends and holidays.

RAND also found that Teladoc was an entry point to health care for many people (21%) who previously had difficulty accessing their regular physician, including employees who were unable to take time off from work to obtain care.  Patients who used Teladoc were 50% less likely to require follow-up consults.  

Interesting Facts

 

Who Uses Telemedicine

  • 76% are women
  • 28% are ages 25-34
  • 34% are ages 35-44
  • 17% are ages 45-54
  • 15% are age 55 or older

How Do People Access Telemedicine

  • 60% access via phone via the call center
  • 30% access via a smartphone app (up from 10% on the previous survey)
  • 10% access online via their computer

When Do People Access Telemedicine

  • 6% access care in the morning before 6 AM
  • 60% access care from 6 AM to 6 PM
  • 34% access care from 6 PM to Midnight
  • 95% access care on weekdays

What Are the Top 10 Diagnoses

  • Sinus Problems
  • Urinary Tract Infection
  • Pink Eye
  • Bronchitis
  • Upper Respiratory Infection
  • Nasal Congestion
  • Allergies
  • Flu
  • Cough
  • Ear Infection

Employers who offer Teladoc

Additional Information

Video – 6 reasons to add Teladoc: 

https://www.teladoc.com/businesses/videos/video-6-reasons-to-add-teladoc

The TelaDoc Experience Page

http://247telamed.com/employers/

 

For information about additional health strategies or for more information about Telemedicine, please contact:

Robert Recchia, CLU ChFC AIF
President, California Corporate Benefits
13475 Danielson Street, Suite 200
Poway, CA 92064
(858) 753-4102 Phone
(877) 222-6843 x102 Toll Free
(619) 840-3373 Mobile

(858) 487-2913 fax
bobr@cabenefits.com
www.cabenefits.com
www.linkedin.com/in/robertrecchia

For me, winning the gold medal is when people look back and feel thankful that we met.

Thank you to our 134 UBA partners across the U.S. who contributed their knowledge and experience to this effort.

 

1 Managed Care, June 2016 “Study Suggests High Deductible Health Plans Not Working as Intended.

2 “Emergency Room Use Among Adults Aged 18-64: Early Release of Estimates From the National Health Interview Survey”, Renee M. Gindi, Ph.D.; Robin A. Cohen, Ph.D.; and Whitney K. Kirzinger, M.P.H., Division of Health Interview Statistics, National Center for Health Statistics, January-June 2011

3 Source: 2017 Merrit Hawkins Survey of Physician Appointment Wait times.

4 The Impact of Telemedicine on Healthcare, Wall Street Journal June 28th, 2016

5 Source: first Stop Health 2018

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