Because they now represent thelargest generational slice of the workforce, millennials arerapidly driving expansion of employer plan telemedicine,and older employees are following suit. (Illustration:Marco Melgrati)

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Five years ago, when talk turned to telemedicine or telehealth, the word“potential” either preceded or closely followed the discussion. In2018, that potential is finally being realized.

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You don't need to look further than a physician's office, abenefits consultant's option packages, or the details of a majoremployer-sponsored health plan. From onlineconsultations to take-home self-diagnostic kits to remotespecialist networks, telemedicine is suddenly everywhere.

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The National Business Group on Health, which represents majoremployers, has charted the growing adoption of telemedicine by itsmembers. Today, 96 percent offer some type of telemedicine benefitas part of their health plan, compared to 46 percent in 2015.NBGH's 2019 Health Care Survey confirmed the shift. “The adoptionof telehealth among large employers has been made nearly ubiquitousdue to health plans offering telehealth to all its members,” NBGHsaid.

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Related: Solving telemedicine's low employeeadoption

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Yes, engagement numbers are still fairly low. Generally, lessthan 10 percent of employees had a telehealth visit last year, theNBGH survey reported. But driving that engagement upward is amongthe NBGH's 2019 priorities.

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The group's vice president for public policy, Steve Wojcik, saystelemedicine is here to stay. “With large employers, adoption isgrowing pretty rapidly. The large employers view it as a value addfor their plan. They believe it will reduce costs over time. Theyjust need to make sure their employees understand that it is abenefit and one that can improve their lives.”

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Wojcik and others interviewed for this article pointed to fourkey factors that have unleashed telemedicine's potential:convenience, demonstrated time and cost savings, greater acceptanceby younger workers, and acceptance by the health care brokeragecommunity.

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Other factors have contributed, among them improved userexperience. Even the smoothest functioning and most effectivetelehealth tools will defy engagement if they are not well designedfrom an accessibility standpoint. But here are the big four thatare unleashing the long-simmering potential of telemedicine.

Convenience: It has to be easy

For patients to accept any changes in the way they receivehealth care, convenience has been shown to be a key to utilization.Avoiding the clinic's waiting room is a powerful incentive for anemployee to test drive an employer plan's telehealth visit with aphysician. Fitbits have paved the way for a flood of products thatdeliver non-invasive, real-time collection of an increasing rangeof health data that allow clinicians to get a much more completepicture of one's health.

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And employer onsite clinics have taken telehealth convenience toa new level. Astute employers are integrating telemedicine into theonsite clinic to leverage the high levels of employee engagement.Services such as First Stop Health can connect the onsite primarycare physician with a nationwide network of medical specialists whocan provide same-day, and sometimes same-hour, diagnoses forconditions and symptoms that are outside the PCP's expertise.Simply put, the telemedicine industry is focused on convenience—andit's working.

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The convenience factor of many telehealth products has opened upnew areas for addressing employee health. Increasingly, the NBGHfound, employers are using telehealth to meet multiple healthneeds: “A trend of note is the growing interest in telebehavioralhealth, or mental/behavior health services made available throughphone or video consultations.”

Demonstrated time and cost savings: Money (saving) talks

Time is money, and employers understand the link betweentelemedicine/telehealth and the amount they spend on employeehealth. If telehealth is convenient, employees will use it. Themore they use it, the more these three outcomes can bemeasured:

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• Time saved by telehealth visits that replace tripsto the clinic;

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• Reduced absenteeism due to improved healthoutcomes;

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• Reduced claims due to improved health outcomes.

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A fourth outcome, increased productivity, remains difficult topin down. In theory, a healthier workforce should be a moreproductive one. But to prove the connection between telehealth andproductivity, employers need more experience and more data.

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The telemedicine industry knows that it must demonstrate toemployers both greater employee engagement and cost savings overtime. Patrick Spain, CEO of First Stop Health, a telehealth networkof medical providers, says the first wave of telehealth devices andservices failed to take into account the employer's need to reducecost as well as to see workforce health improvements. The result:participation barely hit 5 percent.

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“We think the payers, like Amazon and Berkshire Hathaway, arethe most important part of the equation. We think about how we cancreate a better experience at a lower cost for our patient andmember, and then how does that stream back to the client?”

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First Stop Health offers employer plans a nationwide network ofmedical professionals to whom plan members have immediate accesswhen a health concern arises. In a few short years, utilizationamong employees has topped 50 percent—six times the averagetelehealth participation rate NBGH found in its 2018 study.

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Spain says a key was working with employers to promote the plan.“They offered [telehealth] benefits before, but as a copay, andwithout any promotion. We insist that employers help us educateemployees, and we won't charge a copay or anything else.”

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Today, few large employers question the value of a telemedicinecomponent to their plan. According to a 2016 Mercer employer healthsurvey, “Offering telemedicine services has quickly become thenorm: 59 percent of all large employers offer these services, upfrom just 30 percent [in 2015]. Savings for members can besignificant, especially before the deductible is met, as a typicalcharge for a telemedicine visit is $40, compared to $125 for anoffice visit.”

Greater acceptance by younger workers: Millennialism strikesagain

No doubt, millennials are the most surveyed, studied andprofiled generation that has ever lived. Researchers and punditsbroadly attribute any number of characteristics to the simple factthat someone was born between the early 1980s and the mid-1990s toearly 2000s. Research on adoption of new technology clearly showsthat millennials lead the way, and that love of technology hastranslated into a ready adoption of telehealth products andservices.

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“Younger employees are used to getting everything through theirphones,” Wojcik says. “They want to access their health carethrough the same device.”

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Because they now represent the largest generational slice of theworkforce, millennials are rapidly driving expansion of employerplan telemedicine. Led by the millennials' enthusiasm fortelehealth, older employees are following suit. And of course,Generation Z, soon to assert itself in the workplace, is perhapseven more at ease with technology that the millennials.

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Noting the results of the 2017 survey by the Employee BenefitResearch Institute (EBRI)/Greenwald & Associates, The Robert T.Waters Center for Telehealth and e-Health Law remarked: “Theresults of [the survey] are shedding light on something else aboutmillennials: they love telemedicine … Younger health care consumersare happier to receive care in non-traditional health caresettings, including via telemedicine and in walk-in clinics, thantheir older peers.”

Brokerage community acceptance: “I can't sell lowengagement”

In general, health insurance brokers have approachedtelemedicine and telehealth benefits gingerly. They would oftenrather just sell insurance policies and standard benefits; butthat's changing.

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For years, telehealth benefit engagement numbers were extremelylow. And while they remain modest, according to the NBGH survey,they are improving. Some options are reporting employeeparticipation in the 50 percent to 60 percent range, numbersunimaginable just a few years ago.

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Insurance brokers are overcoming their telemedicine benefitsreservations as more clients demand such products and services. “Weare seeing increasing interest from brokers and employee benefitsconsulting firms,” says Anu Nadkarni, vice president, PayerSolutions, Tyto Care, which provides a telehealth solution forperforming comprehensive at-home physical exams and diagnoses.“They see this as a game changer to utilize telehealth benefitsThey're looking at new opportunities, asking themselves, 'Where canwe improve the member experience?'”

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The problem hasn't been with the products or services, saysRachel Miner of Thrive Benefits. Neither brokers nor employers havebeen effective at selling telehealth benefits to employees.“Telemedicine has to be a benefit that people see as a benefit,”she says. “Part of it is making sure people will use it.” If thebenefit offers convenience, saves time, and is easy to use,employees will engage. But first, brokers and employers have to doa better job of communicating the benefits. “For a broker to offerthese services, you need to have strong utilization and have itwork for the client. You have to be able to say, 'Here's the ROI.'And we are finally seeing that.”

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One product she likes is the HealthJoy concierge app.

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Here's how HealthJoy describes itself: “The platform bringstogether medical professionals, advocates, Rx savings, anartificial intelligence-powered virtual assistant, and more into aneasy-to-use app that employees love.”

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Here's how it works for Miner's trucking company client: Adriver is on the road, far from his or her home health-care turf,when a sudden medical concern flares. The driver simply opens theHealthJoy app, places a call to be connected with a doctor todiscuss the condition, and is quickly connected with a medicalprofessional who can start the diagnosis and treatment process onthe phone.

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“You can show the ROI there,” Miner says. “Think of the savingsfor a trucking company client. And what if you can just call adoctor on the road and they will send the prescription to where youare? That's a benefit that works.”

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Read more about the use and benefits oftelemedicine:

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Dan Cook

Dan Cook is a journalist and communications consultant based in Portland, OR. During his journalism career he has been a reporter and editor for a variety of media companies, including American Lawyer Media, BusinessWeek, Newhouse Newspapers, Knight-Ridder, Time Inc., and Reuters. He specializes in health care and insurance related coverage for BenefitsPRO.