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Some Say Virtual Doctor Visits Won’t Work

Here's why they're wrong – How telehealth can help business


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In 2017, a well-publicized RAND Corporation study presented a startling conclusion. It found direct-to-consumer telehealth may not save money because it may increase health care utilization due to ease of access. In fact, researchers estimated an 88 percent increase in the use of specific health-care services among patients studied.

With findings that seem contrary to years of previous research, the study got lots of play, raising important questions for corporate health benefit programs:

Should our company promote plans that offer telemedicine (often called telehealth, virtual visits or remote care)? Or should we urge people to stick with in-person care?

Before you decide, know the RAND research doesn’t tell the whole story. Consider a few facts:

  • RAND compared medical claims costs for telehealth users with costs for people seeking in-person care within just one diagnosis group (respiratory illness). The telehealth user group amounted to fewer than 1,000 patients over a 10-month period.
  • The study did not look at the bigger picture of telehealth’s holistic benefits, including workplace productivity and time savings for patients and care providers.
  • The study also did not consider telehealth’s role in addressing a doctor shortage that is expected to be nearly 50,000 by 2020 and more than 100,000 by 2030.

TELEMEDICINE NO LONGER MEANS TELEPHONE

Originally, telehealth or telemedicine meant just that: Health care delivered over a telephone line, and mainly to people in rural areas with few hospitals or specialists.

Even in 2011, the year RAND’s study started, some of today’s most successful direct-to-consumer telehealth services didn’t exist. Neither did much of the technology that enables video visits.

Today, though, people can go online or log into a special medical app on their phone, tablet or computer for a private, secure, face-to-face online visit. Using live video, a doctor, physician’s assistant or other clinician sees and hears the patient’s concerns and symptoms and prescribes treatment or other steps. Care can happen anywhere with Wi-Fi or data access, at the consumer’s convenience and, in many cases, 24/7. Whether the consultation is with a national telehealth service or a personal doctor, today’s telemedicine enables people to get an unexpected health concern or chronic condition addressed in just a few moments.

WHERE VIRTUAL VISITS PAY OFF

Thousands of studies have looked at the value of this kind of remote care, especially for chronic conditions, follow-up after hospitalization and some types of behavioral health. The cost savings have prompted the federal government and all 50 states to adopt at least some telehealth care for Medicare and Medicaid beneficiaries.

Virtual visits make sense when an in-person medical appointment is inconvenient or impossible, such as during the employee’s workday, after physician office hours or on the weekend. Virtual care can help with minor, non-emergency medical conditions like a bladder or urinary tract infection, respiratory or sinus infection, pinkeye, rash, stomachache, diarrhea or migraine headache. For those with chronic conditions like diabetes or heart disease, telehealth can make regular check-ins with their personal doctors easier, helping them stay on top of their health. Tele-behavioral health is in particularly high demand due to the added privacy of being “seen” in one’s own home.

The benefits of virtual care are clear: no travel time, little to no downtime from work, no waiting room, and a cost that’s appealing to consumers. There’s growing demand for virtual care for good reason:

  • Time savings: Citing a time-usage study published in JAMA, American Well points out that virtual visits save 106 minutes per visit on average, compared to in-person care.
  • Affordability: Most consumers pay about $50 to $75 for a virtual visit. If their health plan covers the visit, their plan provisions typically apply, including copayments or coinsurance. Their payments also may count toward their annual deductible. That’s far less expensive than a $150 visit to an urgent care center or a trip to the ER, which generally costs $1,700 or more.
  • Shorter wait times: When NewYork-Presbyterian’s Emergency Department rolled out an on-site virtual care option, the wait time for lower-urgency ER visits plummeted from 2.5 hours to 40 minutes.
  • Lower ER usage: Doctor on Demand, a telehealth provider, says about 50 percent of its patients would have gone to an emergency room or urgent care if they hadn’t accessed a video visit. These costly and time-consuming care settings are best avoided for non-urgent situations.

WHY VIRTUAL VISITS WILL FLOURISH

The earliest telemedicine technology involved a telephone or spotty video connection. Today’s virtual technology, however, enables care providers to clearly see symptoms like rashes, for example, and take note of body language and a person’s appearance.

Moreover, virtual care helps people get the care they need when they need it, instead of second-guessing themselves – and possibly waiting until they need more serious treatment. The distracted worker who wonders if her kid's cold is actually bronchitis can ask a professional online and then get back to business while the child rests at home. She’ll avoid taking a half-day to drive to urgent or emergency care – and spending significantly more – to be told to wait it out. 

More importantly, the person who does have bronchitis can get symptoms checked right away, day or night. They’ll be alerted to visit their regular doctor in person promptly – possibly avoiding their condition degenerating into pneumonia and requiring a weeks-long recovery.

HOW TELEHEALTH CAN HELP BUSINESS

The upshot? When it comes to care utilization and cost, it’s important to look at the big picture, not a single study. Numerous studies have drawn conclusions that differ from those of the RAND research. In fact, data analyses of a much larger population (1.8 million people) found that virtual care saves money – while resolving people’s health issues with just one visit in 90 percent of cases.

Telehealth’s possibilities are especially compelling for employers. Unplanned employee absences can amount to more than 20 percent of payroll costs each year.

Fortunately, more than ever, your employees can get the care they need, anywhere. Today, 75 percent of firms offer employees the option of receiving medical care virtually, according to the Wall Street Journal. And, as of this year, legislatures in all 50 states have passed laws that allow, enable or expand the delivery of telemedicine for residents.

In 10 years, we’ll likely look back to see that telehealth trends may have started with a spike in utilization – but ended with better health outcomes and lower costs overall. And that’s taking good care of your employees.


Dr. Thomas Biuso is the chief medical director of the west region for UnitedHealthcare.

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