Driven by both economics and culture, telemedicine is a way foremployers and employees to push through the growing medicalbottleneck

Tim Bright's work as a well-site geologist for Denver-basedColumbine Logging Inc. takes him from his home in Las Vegas to jobsall over the Rocky Mountain region. One Saturday in early November,Bright was preparing to go to an undeveloped job site in northernNevada, where he would spend three weeks away fromcivilization.

Then he realized he didn't feel well.

“My throat was sore and my lymph nodes hurt,” he says. “As timewent on, I felt worse.”

Going to his doctor would have meant not working on Monday—if hecould get a Monday appointment—and when Bright isn't working, hedoesn't get paid.

Going to the doctor from his job site wasn't a great choice,either.

“We live and work at the well site, working for a couple ofweeks at a time, then taking a week off,” Bright says. “You'deither have to go to the doctor when it's not your 12-hour shift,or call the boss to send in someone else to come take your shift.The boss is in Denver. I'm in the wilds of Nevada. Calling to getrelief for just one day would not go over too well.”

So Bright used his employer's new telemedicine benefit.

“I had a conversation with a nurse first, then a doctor calledme back and wrote me a prescription for an antibiotic,” Brightsays. “At first I was a little hesitant, because you kind of feellike you want the doctor to see you. But basing a treatment on mydescription is pretty much what they do anyway at a doctor'sappointment. The antibiotic worked, and I think this is a neat ideaand a really useful tool for people like me who work way outthere.”

It's a useful tool for Bright's employer, too. Kurt Sonka, whois Columbine's vice president of accounting, says that inSeptember, the firm began paying $6 a month per employee for atelemedicine benefit from Chicago-based First Stop Health.Columbine offers the benefit in addition to a standard healthpackage.

“A lot of our employees work remotely on oil rigs, so they mighthave to drive 100 miles to see a doctor,” Sonka says.

Talking to a physician by telephone lets workers get health carewithout leaving the job site, which would typically involve a daywithout pay. It also means the company doesn't have to put aproject on hold while it finds and transports a substituteworker.

It's Not a Cure-All

To be sure, there are a lot things telemedicine can't do, fromprescribing opiates to setting a broken bone or biopsying asuspicious lump. But for antibiotics, lower-strength painmedications, antihistamines, basic dermatology, forgottenmedication, and questions about whether an in-person doctor'sappointment is warranted, a doctor who is available by voice,FaceTime, or Skype can be just the ticket, says Deb Loughlin, aprincipal at Digital Benefit Advisors in Colchester, Vt.

“They can triage stuff like hernias, which can be boring or anemergency,” Loughlin says, or suggest an over-the-countermedication that would help someone who can't easily reach apharmacy or is traveling outside the United States, where Americanphysicians can't prescribe.

Some people insist on seeing their own physicians, who havetheir complete medical records. Many more, however, are accustomedto having their needs met immediately through remote technology,particularly when they are nowhere near their regularphysicians.

“People travel a lot more than they used to, and the things theyneed are often urgent, but not emergencies,” Loughlin says.

Other potential telemedicine clients include anyone who's awayfrom home, whether traveling, working, or going to school;college-age adults who have graduated from a pediatrician's carebut don't yet have an adult primary care doctor; people who work inthe wilderness; individuals who are used to technology drivingsimple, immediate solutions; and anyone who can't easily take timeaway from work to visit a doctor.

A lot of people share an enthusiasm for telemedicine, it seems.According to a report from the Wellesley, Mass.-based marketresearch firm BCC Research, the telemedicine market was worth anestimated $11.6 billion in 2011, up from $9.8 billion in 2009. Overthe next five years, the market's compound annual growth will reachan estimated 18.6 percent, with the telehospital and teleclinicsegments estimated to grow at 16.8 percent during that timeperiod.

Growth Spurt

First Stop Health is riding that growth. The Chicago-basedcompany started in 2011 and launched its product in the autumn of2012.

“Our goal is to make the cost of health care lower, especiallyas the cost of health care rises and high-deductible plansproliferate,” says company cofounder and CEO Patrick Spain. “Thiscan help bring down costs, particularly with self-insuredemployers. Telemedicine doesn't cost very much, but it's animportant potential way to save. The challenge is to take somethingthat looks minor and sell it as a potentially major way to save. Wewant brokers to make it part of nearly every package theypitch.”

The time is right for telemedicine, Loughlin agrees. “It'sdefinitely on the rise, driven primarily by economics, but also byculture. It's more and more supported within regulation, andinsurers are being told that they need to support it.”

A variety of bills around the country, both pending and final,will allow doctors to practice telemedicine across state lines andrequiring carriers reimburse telemedicine services.

Cost Controller

On the economic side, Loughlin says, is telemedicine's abilityto tamp down the rising cost of health care by allowing consumersto use less face time with doctors. A company that offers workerstelemedicine in addition to a standard medical plan, she estimates,might save 25 percent on medical costs. If the company isself-insured, that savings goes directly to the bottom line. If thecompany is fully covered, that savings likely translates to lowerpremiums.

Telemedicine saves money, experts say, because physicians chargeless for a telephone call than from an in-person visit. About 50percent of office visits are unnecessary, Spain says.

“The typical family of four goes to a doctor 14 times a year.Eight of those visits could have been handled over the phone. Ifsomeone uses telemedicine, even imperfectly, they might avoid fourof those visits, at about $100 a piece,” Spain says.

When his company road tested its product, “90 percent of thepeople who called got a reduction in the overall cost of theircare, because they downgraded from emergency room to urgent care ordidn't need a visit at all,” he adds. “Only 10 percent of the callswere people that the teledocs couldn't really help.”

Telemedicine also can increase worker productivity, because anemployee doesn't need to take half a day or more in sick time inorder to deal with a medical issue. Because telemedicine offersimmediate access to medical professionals, workers aren't chainedto their desks all afternoon, afraid to attend a meeting becausethey're waiting for a doctor to return their telephone calls.

“Doctors aren't typically paid for telephone calls, and peoplework around getting a call back from them,” Loughlin says.

A lack of pay makes returning patient calls a low priority formany doctors. Others are simply overwhelmed by patient needs. Atypical primary care doctor in Vermont might earn $125,000 a year,Loughlin estimates. In the medical world, that's not a huge salary,so relatively few medical students choose primary care as acareer.

According to a Nov. 7, 2013, article in the Wall Street Journal,only about 20 percent of medical students choose primary carespecialties—pediatrics, internal medicine, and family medicine—astheir focus.

That leaves too few primary care doctors taking care of too manypeople already, and the problem is only getting worse. Millions offormerly uninsured patients will buy insurance through theexchanges under the Patient Protection and Affordable Care Act, and10,000 people will turn 65 every day for the next two decades. By2020, the Association of American Medical Colleges predicts, theU.S. will be short 45,000 primary care doctors.

Those doctors would have acted as medical advocates, in additionto directly treating patients. Spain says telemedicine can helpreplace those services, too.

“If someone has a serious crisis and needs help gettinginformation about treatment options, a telecom can give adviceabout whether that person needs a local provider or a center ofexcellence. Sometimes the wait can be a while at a center ofexcellence, and a medical advocate can sometimes cut down on thewait,” Spain says.

Administrative advocacy is another potential telemedicineservice.

“A surprising number of medical bills are wrong, and not in yourfavor,” Spain says. “One of our members was in a car accident andbroke her leg. The emergency medical technicians called ahelicopter to take her to the hospital, and then she got a $42,000bill for the helicopter ride. An ambulance would have been bothfaster and cheaper. So she called the telemedicine service. Theydid an analysis around whether the helicopter ride was medicallynecessary, and they got the bill down to less than a tenth of theoriginal amount.”

To realize all these benefits, employers, brokers and providersneed to persuade workers to use telemedicine as a first responder.That may not be easy.

“When we started rolling this out to employers and agents, nineof 10 customers had never heard of telehealth. The brokers werefamiliar with it, but sometimes not in a positive context, astelemedicine used to be sold as a low-cost benefit that hardlyanyone used,” Spain says. “In one case, we talked to an employerwho had telehealth for about 300 employees for three years. Inthose three years, no one had called.”

So First Stop Health uses a different approach. The companysends emails, offers webinars, and issues reminders such asstickers and magnets to dispersed workforces.

“We want our customers' employees to use this,” Spain says,adding that his company aims for 20 percent participation—“not theusual 1 percent to 2 percent. If we get 15 percent to 20 percent ofemployees to use the service at self-funded employers, theinvestment will be repaid three to four times.”

It's still early, Spain emphasizes, but so far about 70 percentof contacted brokers seem interested in selling the benefit. Timewill tell how quickly it catches on.

Consumers optimistic about telehealth

By most accounts, telemedicine is rising in popularity amongemployers and health care executives—and now it looks likeconsumers worldwide are receptive to the recent trend.

According to an Intel survey, 72 percent of consumers say theyare willing to see a doctor via telehealth video conferencing fornon-urgent appointments. And half say they would trust a diagnosisdelivered via video conference from their doctor.

This and other findings from Intel reveal that consumers areoptimistic about health care in terms of technology andinnovation.

Some consumers are so optimistic about technology, in fact, thatmore than half believe the traditional hospital will becomeobsolete in the future.

These survey results, says Eric Dishman, general manager ofIntel's health and life sciences group, indicates “very highwillingness of people to become part of the solution to the world'shealth care problems with the aid of all sorts oftechnologies.”

“Most people appear to embrace a future of health care thatallows them to get care outside hospital walls, lets themanonymously share their information for better outcomes, andpersonalizes care all the way down to an individual's specificgenetic makeup,” Dishman says.

The majority of people surveyed also believe that technologyinnovation holds the best promise for curing fatal diseases—morethan increasing the number of physicians or additional funding forresearch.

The study, “Intel Healthcare Innovation Barometer,” wasconducted across eight countries by Penn Schoen Berland in Brazil,China, France, India, Indonesia, Italy, Japan and the UnitedStates.

Other findings from Intel include:

• More than 70 percent of people globally are receptive to toiletsensors, prescription bottle sensors or swallowed monitors.

• 66 percent of people say they would prefer a personalized healthcare regimen designed specifically for them based on their geneticprofile or biology.

• 53 percent of people say they would trust a test they personallyadministered as much or more than if performed by a doctor.

By Kathryn Mayer