Telemedicine is here to stay, and you should know how it works. That was the consensus at the Workplace Benefits Renaissance in Atlantic City, N.J., in February. In fact, it can save your clients money while increasing your voluntary sales. "I have a client who saved $1.2 million last year via telemedicine," said John Conkling, a panelist at the show and vice president of Fringe Benefit Group in Austin, Texas. "It's instead of employees going to the ER."

The concept of telemedicine, defined by the American Telemedicine Association as the use of electronic communications from one site to the other, isn't new. In fact, it's been around for nearly 40 years, initially using phones to connect people with medical conditions in remote or rural areas with their physicians. It's now evolved to video, email, smart phones, even a social media network. And it's no longer just for those who are miles from the nearest hospital.

"As my wife and I learned from raising kids, they don't get sick at convenient times, it's in the middle of the night at 1 a.m.," said Chris Bernardine, a consultant from Philadelphia, during the panel.

Bernardine went a step farther to predict its eventual explosion: "Our kids' generation spends so much time on their smartphones, someday they'll do [telemedicine] just to avoid sitting in any waiting rooms altogether."


Getting down to business

So where does telemedicine fit in for a broker? It's a great added revenue stream. According to Tom Moletto of Weston Benefit Card Services Inc. in Charlotte, N.C., brokers should take two steps in selling telemedicine:

1. Calculate the savings for the employer and employee and communicate the results to them to sell the product in a package with other voluntary benefits.

2. Suggest that flex spending accounts can be used for telemedicine.

He told the attendees that it's easy and it makes sense for brokers because "we all need to get more into voluntary."

The cost savings and ease the product brings to the employee should be communicated effectively so that employees tell their peers and the product begins to sell itself, Conkling added. The goal for a broker should be for telemedicine to go "viral in the organization," he said.

The panel outlined the two main models for an employee to have telemedicine deducted from their pay check:

1. The first option is for a lump sum to be deducted at around $12 per month. That would cover approximately six family members for all their telemedicine needs throughout the month.

2. The second option works by deducting a smaller amount, such as $3 per month. But it then requires a $35 consult fee once a session is actually initiated; the employee would owe about $10 of that fee and the employer would pick up the rest.

However, the panel pointed out that a broker should be cognizant of who they are selling to with each of these options. If dealing with an employer that's a non-profit, for example, the employees may not be able to afford the $35 option for multiple consults within a given month.

The panelists agreed that it would not be wise to recommend that a group or individual ever completely drop their medical insurance coverage. "Telemedicine is for the things like antibiotics, getting those things faster and cheaper," Conkling said.


Potential consequences

A recent study by The Journal of the American Medical Association pointed to several positive results after a group of researchers looked at telemedicine - but also found a potential drawback.

The data did not show any significant difference in the number of follow-up appointments that resulted in the study comparing telemedicine visits and in-person visits. These results could increase the number of doctors who are willing to continue to practice telemedicine, or begin to offer it, the study pointed out.

The authors of the study also reported that "patients appear generally satisfied with e-visits."

The concern the study raises, however, is that telemedicine visits had a higher number of antibiotic prescriptions than in-person visits, when controlling for similar symptoms like those of sinusitis and urinary-tract infection.

The authors wrote, "physicians may use a 'conservative' approach and order antibiotics," indicating a feared consequence of bacterial resistance or simply unnecessary medication.

"When I'm looking at the patient via screen, I always worry that I'm missing something and I think the higher prescribing rate comes from that 'Am I missing something?' question," says Dr. Dimitri Drekonja, assistant professor of medicine at University of Minnesota and infectious disease physician at the Minneapolis VA Medical Center, who was not part of the study.

"Doctors provide themselves a bit of comfort on the borderline cases by prescribing antibiotics," he adds.

Drekonja notes that in addition to bacterial resistance, the risks associated with the usage of antibiotics are drug allergies and interactions, prolonged heart rhythms and a more severe form of antibiotic-associated diarrhea.

Even so, in the long run, industry consultant Bernardine thinks that the higher number of prescriptions will be seen in a positive way once more studies really look at the trend. "In the end, it's so much less expensive," he said following the panel at WBR. "It's just so much less for a phone call plus the prescription than the visit plus the prescription."

"The doctors don't just pick up the phone and ask you what you want," says Greg Schlatter of New Benefits in Dallas, a group that sells telemedicine in a bundled package to reduce the cost down to a fraction of what it would normally be. "It's evolving to work almost in partnership with primary care doctors."

He explains that telemedicine users must upload their full medical history through a secure online portal and that the doctors must go through a patient's medical history before discussing their current symptoms. He says that when things do seem questionable, telemedicine doctors may prescribe something, but also tell the patient to go into their local doctor's office shortly thereafter to double-check the diagnosis.

"I've seen data that also show that 70% of regular doctor visits aren't required if a person could speak with a board-certified doctor over the phone," continues Schlatter. "We're not replacing primary care - we're supplementing it. We're moving the so-called nuisance sicknesses to allow doctors' offices to treat people who have more serious conditions."

Drekonja is careful to add that his specialty in infectious diseases and work with the VA means that he provides his telemedicine care free of charge.

"I have some patients coming from very far away, so offering this means they only have to take an hour off of work versus an entire day," he says. "But it does mean a lot more paperwork for me and less time to spend on research, because I prefer to conduct telemedicine interviews on days I'm not seeing patients in the clinic."

But most doctors who will be facilitating the voluntary services that brokers and agents are offering will work with a different model.

Teladoc is one of the largest vendors of telemedicine products and employs a large number of semi-retired or retired primary care physicians, although some are still practicing. The doctors can choose whether or not to take the call, so if they're busy with another patient, the call gets routed to the next available Teladoc board-certified physician.


The next step

For doctors, the future means the use of tablets and data applications to heighten their time and efficiency with patients, even monitoring their vital signs from their homes using mobile health to require less travel.

According to the ECRI Institute, a non-profit focused on patient care, mobile health is a top technology trend for hospitals to watch in the near future.

ECRI suggests that patients with chronic illnesses like diabetes and cancer will have more sophisticated applications on their smart phones in the near future, some that will even allow for interaction with their doctor.

For health insurance brokers and agents, the future means diversifying products and relying more heavily on the voluntary space for sales. "That future is just beginning," says Schlatter.

While Teladoc has more than 5 million subscribers today, he says that most brokers don't really know about telemedicine or how to install it into a group insurance offering. He adds that trade journals and conferences are good ways to stay on top of trends like this one, and he thinks that in no time telemedicine will become one of the top legitimate offerings that brokers can provide for employers.

"It's in its infant stage," says Schlatter. "There's a lot that can be done with it, even outside of group and individual insurance.We need to think creatively to sell this - perhaps at college campuses. It would make a lot of sense to have students who all get sick with the same flu to call in to discuss their symptoms rather than trek all over campus."

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