Telemedicine still faces roadblocks despite employee enthusiasm

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Telemedicine and the use of social media-like bots have been popular with employees — except when it comes time for them to visit an ER or local urgent care center. At the EBA Workplace Benefits Renaissance conference this week, First Stop Health President David Guttman and Teladoc Vice President Anne Stowell discussed the challenges of implementing a solid telemedicine program, the data that CFOs and HR executives want to see, and what employees want to hear when they have a sore throat. Julian Lago, president of Florida-based national healthcare advocacy firm Benezon, moderated the panel. This session transcript has been edited and condensed.

Julian Lago: Where do you see growth of AI and bot technology for telemedicine?

Anne Stowell: When you think of growth of new tech, like Amazon Alexa and Echo, it’s important to put it in the context of healthcare. People are attracted to these tools and expect a way to interact, request a service and get updates. Apps and text and social media are making it easier for us to make that layer disappear and access care. We don’t have to reinvent the wheel.

When you think about healthcare, you have to think about privacy and security but also about what makes people most comfortable. If you look at how people use our service, it’s 30-30-30. Thirty percent use their phone, 30% access the website and 30% use the mobile app.

It’s fascinating that the people calling on the phone and not using an app want to talk to someone. They feel it’s important who they engage with when it comes to their doctor.

David Guttman: These are cool new toys and people love technology, but people miss the fact that technology introduces barriers. You have to go to websites, register and download apps. The statistic we have is 90% have telemedicine through their carrier, but less than 1% use it for a consultation. I think the best uses of AI are on the back-end for claims analysis and doing data-driven engagement and intervention.

Lago: We have some projections about the use of telemedicine: $36 billion by 2020, 50% of states have some type of telemedicine bill and 75% of patients have interest in telemedicine encounters. Where is the largest growth?

Guttman: The single biggest challenge of telemedicine is we are attacking the most relatively modest portion of the medical spend. We can attack 3% of total spend — it’s not nothing — but for this to be relevant with the CFO and HR, this is the biggest challenge we have. We need to attack other spending, like pharmaceutical dollars, etc. That is the direction we are trying to go, not just getting more people into the system but to attack those dollars.

Stowell: Accessing care in this way will be more common. During the flu season, there were huge cases of people trying to get Theraflu, but they might be more reluctant to look to telemedicine for chronic care or more serious diagnoses compared to something that is more episodic. We have to be able to address complex cases through a variety of clinical needs.

Lago: How do we measure success for a telemedicine benefit?

Stowell: My Pollyanna vision is everyone gets really great care and they have access to it. Success [is measured by] the adoption of the platforms, engagement in overall benefits package and cost and ROI. To make the system work, we should be able to get people to the right kind of care that costs the right amount of money.

Guttman: This is the single point of frustration from HR and benefits people — they put the benefit in place and no one uses it.

One thing you can be sure of: if no one uses it, there was no capital created. You have to drive the organization to make people use it. We want to be as transparent as how we are going to measure savings. There are hard and soft savings. If you call for bronchitis before it becomes pneumonia … then we look at people who didn’t go to ER because they used telemedicine — that is what we have to measure.

Lago: What are the challenges of engagement?

Stowell: One misconception is that driving awareness is enough. Being able to remind them of that or be present when they are in actual need of these services is key. Usually during open enrollment, we say, “Here is a flyer and here is your welcome kit for XYZ service.” We should be able to say, “You used the ER four times last year for strep throat.” And we can send them some type of communication about that.

We need to be specific and contextual. Right now we are in peak utilization because this flu season has been very, very intense. Making sure you are driving engagement so that people use your service is critical. And finally, there is a lot of data out there but it is challenging getting it to people. If I had Teladoc and I am travelling, I would Google “urgent care.” But this is the moment to remind them that they can use telemedicine. The more sophisticated we can get the more success we will have driving this healthcare service.

Guttman: The biggest misconception is that it will sell itself, and that hardly ever happens ever.

About 75% of engagement can be cookie cutter – mailings, email and so on. It’s great but it’s hard to get them when they have a sore throat. That is almost impossible to do. We found that we have to tell them and tell them and keep telling them.

You need outside-the-box thinking to reach them. We have to plan ahead of time. We have to get the entire company in groups of 20 to go from 0% to 80% utilization in 60 days. You have to be heavy-handed like a digital thermometer with the phone number.

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