Employers Embrace Telemedicine But Employees Exhibit Uncertainty

Lee Damiano felt ill one day in May 2015. The previous year when she signed up for her employer’s new telemedicine benefit that would allow her to contact a doctor any time, any day of the week, she thought she’d never actually use it.

She was wrong. Initially thinking, “I might as well wait until Monday,” Damiano ultimately called and was speaking to a doctor within 10 minutes. “As we went through the symptoms, the doctor encouraged me to go to the ER. I’m so glad I listened,” she said. “I had several pulmonary embolisms that could have been fatal over the weekend.”

Damiano, the senior vice president of Denver-based Westerra Credit Union, is now a big proponent of telemedicine for the organization’s 260 employees. “A number of things happen off hours and on the weekend,” she said. “It is critical to provide our employees cost-effective options.”

Westerra is one of many U.S. companies offering telemedicine, which is the usage of technology to deliver medical care that would otherwise be delivered on-site or in person. Telemedicine — a term that’s commonly used interchangeably with telehealth, although technically the words have slightly different meanings — can include texting, video and phone calls.

But despite employers’ newfound infatuation with it, employees don’t appear nearly as enamored. Only 3 percent of employees in the companies that offer telemedicine used those services in the first half of 2016, according to the National Business Group on Health’s “Large Employers’ Health Plan Design Survey.” Conversely, the same report found that 90 percent of the large employers offered the service in 2016.

As more employers look toward telemedicine as a low-cost, convenient alternative to an in-person visit for routine types of medical care, they’ll need to address skeptics’ concerns. Many employees are not accepting the technology as an appropriate substitute for in-person doctors with the same enthusiasm as their employers.

Meanwhile, some physicians remain neutral regarding telemedicine. Dr. Jack Resneck, professor and vice chair of dermatology at the University of California at San Francisco and an American Medical Association board member, said telemedicine is not something they are for or against.

“We see it as an additional tool that actually has great potential,” Resneck said. “This is an area we’re excited about. We just want to see it done right so patients get good quality care.”

Employee Utilization and Communication 

Although the trend for employers is rapidly increasing adoption of telemedicine, employees aren’t necessarily buying in as quickly, said Dr. Aamir Rehman, partner and senior clinical and total health management strategy consultant at Mercer. Growth is steadily increasing, but it’s still low.

A couple of factors may influence low utilization rates, Rehman said. In some cases, it’s simply informational. Employees might not know that their employer offers it.

Other employees may know it’s an option for them but feel more comfortable seeing a provider face to face. Rehman added they could be uncomfortable using telemedicine and have qualms or questions such as, Is this person a real doctor? How can this doctor tell what’s wrong with me without being in the same room?

“These are issues employees have brought up, and employers with a high utilization rate have succeeded in communicating and addressing these concerns,” said Rehman.

There are certain talking points for employers to focus on when communicating telemedicine, he added.

“If you can get me to the right provider at the right time, then the outcomes will be better. If you have a problem at midnight or it’s noon and you’re at work and (telemedicine) can take that hassle out of accessing health care, then the outcomes will be better. That is the primary message,” he said.

Clinical outcomes are often equal to that of a brick-and-mortar provider while costing less, said Rehman. It’s less expensive to access care through telemedicine than an office visit. On average, a telemedicine consultation costs $40 compared to $125 for an office visit.

About half of Westerra Credit Union’s workforce use telemedicine throughout the year, said Damiano. One important factor in getting that high usage was a robust communication strategy, especially during allergy season in the spring and flu season in the winter. This communication included giving instructions about using telemedicine and in which cases it should and should not be used.

The Alvin Independent School District in Alvin, Texas, also successfully uses communication strategies to increase utilization. Donnie Marek, director of risk management, runs a self-funded medical plan for the district, which employs about 3,000 people across 30 campuses.  “Any time you have a self-funded plan, you look for opportunities to slow down claims and provide better services for your employees,” he said.

The district began offering telemedicine in September 2014 through Teladoc Inc. after Marek researched opportunities to reduce claims. It averages a 21 to 25 percent monthly utilization rate, which is good for an organization of its size, he said. Communication is key to its success rate, he added.

“Our district was a very reactive district for health insurance. When I was hired I flipped that to be very proactive. [Employees] are constantly getting information from my office,” he said.

Marek sends out monthly emails to all employees, provides information to new hires and looks for employee testimonials with a positive experience with telemedicine. “If I get a good testimony from someone who has used it, I’ll ask them to write up a quote, and I’ll put it in the next blast that goes out. We’ve branded it well at our district,” said Marek. It’s also helped to have leadership buy-in from several school principals.

To communicate the telemedicine benefit to employees who still do not use it, Marek has other plans for the fall 2017 semester. He, along with one other person, will visit each campus throughout the calendar year and attend faculty meetings at the current 30 campuses, along with two more opening up this fall.

“We’ll talk about insurance and wellness, and telemedicine will be a huge part of the presentation. Getting in front of each employee in a smaller setting, they’ll listen,” he said. “I’m sure I’ll be blown away by how many people don’t know about it, simply because people still don’t read emails. I’m excited about this.”

Making the Practical and Ethical Choice

There are hundreds of telemedicine providers with varied focuses, said Richard Foust, chief business officer of Chicago-based laboratory diagnostics company Analyte Health.

When choosing a provider, “It’s important to ask questions about their approach to telehealth, because they’re all different,” he said. “If the HR manager is really thinking about what’s important, based on the size of the company and the employees they have, the decision will be different.”

Employers should question the telemedicine company’s growth, Foust said. Adding lab testing will become increasingly critical to a telemedicine company’s development since physicians would then be able to make decisions not only based off what they see and hear from the patient, but also medical facts that come back from a test.

Questioning quality is also important. “If I am going to be getting access to a physician at any point in time, how does that telehealth company ensure that I will get a good doctor?” said Foust. “And is that doctor part of a practice that readily reviews how they are treating patients, the outcomes they get and the feedback they receive?”

When an employer chooses a provider, it also has a responsibility to offer telemedicine ethically, said Resneck. “I’ve seen some things that have worried me and been challenging around some quality and patient-safety issues.”

The AMA released a set of guidelines for ethics in telemedicine in June 2016. It took three years for the AMA to develop the guidelines, which define a high standard of care to strive for in telemedicine.

“The area that’s concerned me the most is care coordination,” said Resneck. Care coordination — defined as “deliberately organizing patient care activities and sharing information among all of the participants concerned with a patient’s care to achieve safer and more effective care” by the Agency for Healthcare Research and Quality  — is an area where employers may fumble, said Resneck.

“In the employer market, we have seen a lot of employers reaching out and looking at this as a benefit for employees, which is great, but the temptation I think has been to take the thing that’s the easiest to scale up quickly,” he said. Sometimes what’s been the easiest to scale up has been telemedicine providers that provide fragmented care.

Resneck sometimes sees a patient using a telemedicine model where the provider of care doesn’t know who the patient is, doesn’t have their medical history and doesn’t share medical records after the virtual visit. Also, sometimes when a patient uses a telemedicine service to set up a consultation, the health plan may not cover a follow-up with the primary care physician they regularly see.

Large and midsized employers shopping for health insurance or working with health plans are in a unique position to drive the conversation. They have an opportunity to say, “If we are going to work with a health plan to include telehealth as a benefit, let’s sit down and talk with the health plan and talk about ways to cover this coordinated care,” Resneck said.

“If we saw employers pushing health plans to actually cover things like follow-up care with established physicians and care teams who know those patients, we could provide high-quality, coordinated care in a way that would be more efficient for patients,” he added.

Employers should also push for proper identification of the physician, he added. Patients should know who their physician is and what their credentials are when they are seeking out care via telemedicine. “We definitely see telehealth providers where that is the case and others where that is not the case,” said Resneck. Employers should encourage proper identification and transparency of credentials when they’re in talks with these health plans.

That all being said, doctors and physicians embrace innovation, he added, and they see incredible potential for telemedicine to improve patients’ access to care.

Westerra’s Damiano has seen this potential in her employees’ experiences. Many of them access the service off hours and avoid going to the ER for something that ends up being relatively minor, like an earache. Meanwhile, in her own experience, it’s meant something even more significant than one unnecessary ER visit. A pulmonary embolism, a sudden blockage of the major blood vessels in the lung, can be deadly.

“If I hadn’t called the doctor, I wouldn’t have gone to the hospital,” said Damiano. “It was a lifesaver for me.”

Andie Burjek is a Workforce associate editor. Comment below, or email at editors@workforce.com. Follow Workforce on Twitter at @workforcenews.