With the way the industry is quickly gravitating towards technology, it’s a good time for brokers to consider adding telehealth coverage options for their clients. So much of life — work, family, entertainment — now takes place online, so it’s no surprise that health care delivery is increasingly happening online as well. In early 2016, the American Telemedicine Association reported that there were 1 million virtual doctor visits in 2015. The Association projected that that number would grow by 20 percent in 2016.
However robust the growth rate, virtual visits represent a very small proportion of the 922.6 million recorded doctor visits in 2013 by the National Ambulatory Medical Care Survey. Still, there are several reasons to believe that telemedicine is on an upward trajectory.
In March 2016, Avizia, a telehealth platform provider, surveyed 280 healthcare providers and found that 72 percent of hospitals and 25 percent of physician groups offered some form of telemedicine. And tellingly, the National Business Group on Health’s 2016 survey of 140 companies found that the majority of large employers (those with a workforce of 5,000 or more) offered some type of telemedicine benefit. The Group forecasts that by 2020, virtually all large employers will provide some type of virtual health coverage for their employees. A broader survey conducted by Mercer in 2015, which sampled 2,500 companies with 10 or more employees, found that 60 percent provided some type of telemedicine coverage, double the percentage that had done so the year before.
Telehealth is poised to grow
There are plenty of good reasons why telehealth is poised to grow. For one thing, it provides crucial health care services to those in communities served by few practitioners in general, not to mention fewer specialists. Cost reduction is another reason underlying the telemedicine health trend, especially in areas like chronic disease management and the effects of aging. For both preventive care and acute incidents, telemedicine has been shown to reduce the number of expensive ER visits and inpatient hospital stays.
Technology is a prime enabler of telehealth growth. Most of us have probably seen older movies in which a doctor stands behind a ham radio operator and coaches someone in a remote, blizzard-bound village on how to perform an appendectomy. The technology has certainly improved since then. Video conferencing applications have become so sophisticated that the virtual has actually become close to the physical. Monitoring equipment — increasingly embedded in a patient — can report back on vitals in real time. Health tech and insurtech companies are proliferating, offering a wide range of health- and wellness-related applications. And most Americans are equipped to access telehealth services. Earlier this year, Pew Research reported that 77 percent of Americans have smartphones, over half have tablets, and 73 percent of all homes have broadband. Across the board, people are becoming comfortable using applications like Facetime and Skype to communicate.
Patient demand will also drive the adoption of telemedicine. For older patients, telemedicine allows them to stay at home to receive care, eliminating the stress of getting to and from appointments. For remote workers, especially those who work far away from health services, telemedicine makes a lot of sense. For millennials and other digital natives used to communicating virtually, the desire for telemedicine will come naturally.
Given the pace and stress of life today, it’s not just the elderly, the telecommuter, and the millennials who’ll want to take advantage of telemedicine. Because it’s so convenient, it’s likely people will increasingly gravitate toward it. Studies have shown that the care for many ailments is equivalent in terms of quality to that provided in person, and that patients are satisfied with the level of care. A 2016 survey reported by the National Institutes of Health (based on responses from over 3,000 patients treated via telehealth at a CVS MinuteClinic) showed that between 94 percent and 99 percent were “very satisfied” with telehealth. One-third of respondents actually preferred the telehealth experience.
The insurers are coming around
Many insurers have been somewhat reluctant to offer telehealth coverage. Despite the fact that some forms of telemedicine have been practiced for decades, it’s still not used widely. Insurers may fear that costs under telehealth could escalate. In addition, the definition of what constitutes telehealth is not yet fully formed. What if physicians began billing for every quick text message exchanged or email answered? And what if these text messages and emails are additive, or not connected with an in person visit?
Under the Affordable Care Act (ACA), the federal government did take some small steps towards telehealth. Admittedly, the ACA efforts were only with respect to Medicare, and only in a limited set of situations (i.e., the patients must be in rural locations, can’t be seen in their own homes, and their visits must be conducted via an approved telehealth site). At the state level, telehealth coverage provisions differ from state to state, many having implemented regulations governing telehealth coverage with respect to Medicaid and private insurance. What services are reimbursed for, and how parity between virtual and in-person services is defined, vary widely.
Despite the complexity surrounding telehealth, and all the unknowns, most major insurance carriers offer plans that cover the provision of general medical care via telemedicine, and many provide telehealth-based mental health services as well.
How can brokers offer the best telehealth options for their clients?
Given the many benefits that come with telehealth, brokers should strongly consider including telehealth in their offerings. Not only is it beneficial for employers and individual clients — it positions brokers who do offer this type of service in their benefits packages as innovative. But how can brokers approach the telehealth issue with their clients and the individuals they’re working with?
First, it’s important to stay ahead of the curve by anticipating client needs. This means offering telehealth solutions before client demand rises; however, brokers should do more than simply insert these options into their benefits packages just to have them. To provide clients with the best ROI, it’s important to compare vendors, starting with the type of services they offer and the communication channels they use to consistently engage with individuals (mobile apps/mHealth, email, live video, remote patient monitoring, etc.), followed by which providers they use and who is covered.
While it’s important for brokers to consider their own needs, particularly when it comes to cost, it’s worth keeping in mind that solutions with higher quality services may add value for clients in the long-run.
Of course, telehealth isn’t a replacement for in-person medical visits. Still, for many routine visits like care for chronic conditions and mental health services, telehealth can work quite effectively. It’s promising in terms of its potential for cost savings, and, as people become more and more used to virtual living, convenience and time savings benefits will win out.