Employers Embrace Telehealth, but Roadblocks Remain

by Rebecca Vesely, iHealthBeat Contributing Reporter

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Janel Woods woke up one recent morning, looked at herself in the mirror and saw a bad case of pink eye.

The manager of talent strategy and development at Blue Cross and Blue Shield of Minnesota had to get her kids ready for school and herself ready for work.

"My mindset was, 'How do I solve this in the quickest way possible?'" Woods said.

So she logged onto her work laptop, which she had fortunately brought home the night before, and got onto her employer's telehealth video service, called Online Care Anywhere. She was already registered for the service -- she had used it once before to consult with a doctor when her son was experiencing migraines. Within 15 minutes she had completed a video chat with a nearby physician licensed to practice in Minnesota, who called in a prescription to Woods' local pharmacy.

"I had the medication before the kids were on the bus to school," she said. "It was such a timesaver with us running in so many different directions."

Pretty soon, Woods' experience might not be out of the norm.

As employers continue to look for ways to reduce health care costs and absenteeism while increasing worker productivity, and as consumers become more adept at videoconferencing, workplace telehealth services are poised to become mainstream.

But experts caution that key issues such as provider reimbursement and credentialing across state lines still need to be adequately addressed. Additionally, it's unclear whether telehealth will further fragment the patient care experience or enhance the push toward more comprehensive, continual care.

Employers Eye Telehealth

More companies are pursing telemedicine, according to a new survey of nearly 3,000 large employers by the global consulting firm Mercer. In 2011, 11% of large employers -- those with at least 5,000 employees -- said they have a telemedicine program in place, up from 5% of large employers in 2010, according to Mercer.

"Anytime a survey response jumps like that we sit up and take notice," said Alexander Domaszewicz, principal at Mercer.

What's more, another 38% of large employers surveyed said they are interested in pursuing telemedicine.

"It's getting to be more credible," Domaszewicz said. "It's a growing trend and employers are looking at it in a serious way."

Blue Cross and Blue Shield of Minnesota is seizing on the employer interest by offering a telemedicine service to companies, which launched in mid-2011. The Saint Paul., Minn.-based insurer piloted the program with its own employees starting in late 2009. So far, participating companies run the gamut from small businesses to municipalities to Fortune 500 companies. The insurer declined to say how many employers have signed up.

Using technology from American Well, an online telehealth provider, participating employers can set up a dedicated, private office space with a video camera, computer, telephone, blood pressure machine, thermometer, scale and other biometric screenings. Participating physicians are affiliated with local hospitals including Fairview Health Services in Minneapolis.

"Employees can get up from their desks, go down the hall and see a doctor and be done within 30 minutes," said Kathy Danmire, vice president of product development for the Minnesota Blues.

So far, the savings are being assessed in several ways. For instance, participating employers are seeing average productivity savings of one to three hours. Some 20% of employers participating said they are saving more than three hours in productivity per visit, Danmire said.

Meanwhile, participating employers save an average of $55 in medical costs per telehealth visit. An Online Care Anywhere visit costs $45, compared with about $100 for an urgent care clinic visit, Danmire said

In addition, patients are reporting, on average, a satisfaction rating of 4.7 out of 5, Danmire said.

Common diagnoses through the telehealth program include sinusitis, upper respiratory infections, bronchitis and urinary tract infections. Pediatric care also is proving to be a popular aspect of the program.

"People don't want to bundle up their sick children and go sit in a doctor's office," Danmire said. "That wasn't top of mind for us when we launched, but it is coming up."

Barriers Remain

Domaszewicz of Mercer warns that telehealth is not a panacea for employers. "It's not something to balance the budget," he said.

The reimbursement model remains a major drawback, he said. Large, self-funded employers are unsure how to account for telehealth visits, and it's not included in the current ICD-9 insurance reimbursement codes.

The Minnesota Blues get around the reimbursement issue because it is an insurer offering the service to employers. The program is available at no cost to employees. The cost to participating employers depends on the number of employees and demographics.

Another possible roadblock to adoption is that telehealth could further fragment care delivery at a time when the reimbursement model is moving toward more of a medical home concept for patients.

"The danger is one hand not knowing what the other is doing," Domaszewicz said, adding, "You have the desire for a medical home, but then you also have the need for the quick and the convenient. To some degree, those are conflicting and contradictory."

Widespread adoption of electronic health records could help solve this issue -- if telehealth programs could be set up to feed information into existing EHRs kept with a patient's primary care provider, he said.

Some employers that have tried telehealth ultimately shied away from the concept after finding that these obstacles were too great and that patients weren't getting the holistic care they needed.

Lincoln Industries -- a Lincoln, Neb., metal finishing and supply chain manager and leader in workplace wellness -- dropped its telehealth program for these reasons.

"We found that nothing can replace that face-to-face contact of an in-person visit," said Andy Hunzeker, chief financial officer and vice president of finance and IT at Lincoln Industries.

The Minnesota Blues are still in learning mode about telehealth, said Danmire. The insurer is looking at how physicians can integrate it into their existing practices to help provide a more seamless care experience.

"We see with the patient-centered medical home evolution in Minnesota. Maybe this is a model to consider," she said.

Additionally, the insurer is trying to figure out how to expand the program across state lines, particularly for Minnesota-based large employers with offices in other states.

Health care providers participating in telehealth must be licensed in the state where the patient is located. So, for instance, a worker who lives in Wisconsin cannot log onto the telehealth service from home and receive treatment from a Minnesota-based physician. They must be sitting in Minnesota to "see" the doctor.

Some large employers are solving this problem of credentialing by employing physicians licensed to practice in more than one state. For instance, San Jose, Calif.-based Cisco Systems offers telehealth to employees in Raleigh-Durham, N.C. The physician treating these patients is licensed to practice medicine in both California and North Carolina, the company said.

Such telehealth rules need to catch up to the way we live now, Domaszewicz said. "As people's lives become more just-in-time," he said, "it would nice for health care to embrace this century."

evan yu
Easy access to a consultation is fantastic and the quick response time to the pharmacy to pick up a prescription. That is a great mini-story to help others understand the necessity of telemedicine and telelehealth because it can save time and money. Reimbursement barriers are slowly being taken down with Vermont stepping into offer reimbursements. People want to be taken care of in real time and sometimes that face-to-face consultation is not needed. Solid article!

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