Telemedicine benefits have garnered increased attention during the COVID-19 pandemic as people look for ways to avoid going to the doctor or simply can’t get an appointment with their primary care provider.
A new International Foundation report Employee Benefits in a COVID-19 World found that while 83% of organizations offered telehealth services before the pandemic, an additional 13% have added telehealth services since the outbreak. And because of the coronavirus, half of employers have reduced or eliminated cost-sharing for telehealth.
Sara Hames, CEBS, director of disruptive strategies at Hays Companies, expects the effects on telemedicine to be long-lasting as people appreciate the convenience and low costs of these visits. She discussed the basics of telemedicine, including its advantages and disadvantages, with International Foundation editor Kathy Bergstrom, CEBS.
What kinds of health care delivery are considered telemedicine?
Telemedicine is a generic term meaning talking to a doctor or a provider over the telephone. That has morphed into FaceTime visits, Zoom visits, etc. It can be talking via face-to-face video or via the phone or even via email. If it’s a remote visit, it’s generally considered telemedicine.
Telemedicine is offered by a vendor that offers access to a pool of providers. You likely won’t know them. If you call a second time, you’re probably not going to talk to the same provider. There’s a fairly new service called virtual direct primary care, where employers interview and choose a provider or providers they want to connect their members to. Instead of calling in to a big pool of providers, members can talk to the same provider or one of a few providers every time they call in.
Pre-COVID-19, some doctors were already offering telemedicine on a limited basis and probably at their own choosing. Some who were comfortable with it might televisit with their patients, and others might not. With COVID-19, accessing medical care through telemedicine is going to become as normal as going in for a physical, face-to-face visit.
Telepsychiatry in behavioral health is becoming very popular. Employee assistance programs (EAPs) have been doing this for years. But to get a regular provider is still challenging. There just aren’t enough mental health providers to satisfy the market and the need.
How does a telemedicine visit usually work?
If the visit is connected to a health plan, vendors have the patient’s eligibility listing. When patients call in, the vendors know that they’re connected to the health plan. Vendors also know if the visit is free or if they have to charge a credit card. But participants do have to register for the service. The biggest complaint we get about any type of telemedicine is that people don’t register ahead of time and then, when they have a need, they must go through a 20- or 30-minute process to provide some history, such as age, medical history, medications, etc.
Providers may be available to talk to patients on the spot or, if there’s no availability, may have to call them back, generally within ten to 30 minutes. Wait time has increased somewhat with COVID-19.
After the visit they may charge a credit card, depending on the patient’s health plan. A lot of plans might pay their vendor $2-$3 per month per employee to have the service, and the calls are charged to the plan, usually between $45 and $70 per call. Other vendors charge a higher fee, but it includes all the visits.
Telemedicine is best used for simple, acute issues like a minor burn, pink eye, an earache or flu symptoms. In general, patients are calling for primary care reasons. If it is a specialty issue, providers will say they can’t help with that issue or, if appropriate, they’ll tell patients to go to the emergency room. That said, some telemedicine companies offer the ability to connect with specialists, too.
The visit may result in a prescription. In that case, the provider generally will send the patient an email or may call the patient’s pharmacy.
A virtual visit might be on the phone, but if the patient has a rash or something the doctor needs to see, they might be asked to take a picture and email it.
[Related Reading: Employers Encouraged to Promote Telehealth Services During COVID-19]
What are the advantages of offering a telemedicine benefit?
Telemedicine is a low-cost alternative, and it’s a known cost. That cost is going to vary by plan, but the members should know what it is going to cost them, if anything, when they make the call.
It’s convenient. Many of these services are available 24/7/365, so whether it’s 2:00 in the morning, or a person is at work or getting ready to go to work and not feeling well, they can call in. Maybe they can get a prescription for an antibiotic that they can pick up on the way to work.
If a large part of your population is not on your health plan—maybe they’re going without coverage or they’re on their spouse’s plan—offering telemedicne is a very low-cost but appreciated benefit, because members do have access to some medical care at a very nominal cost.
There’s a generally high satisfaction rate. It is a benefit that can be very much appreciated by employees.
What are the disadvantages?
One potential disadvantage could be that Millennials or people who don’t require a lot of health care may not seek out a primary care physician if they know they have a telemedicine option when they need it. Then, when they do need a primary care physician, they may have trouble getting in to see one.
What’s the best way to get participants to use the benefit?
Communication, communication, communication. Often plans talk about it at open enrollment, but nothing happens until the next open enrollment. People forget. Plans need to keep reminding them. them. Believe it or not, magnets work well. I have a client who uses a key fob, and stickers are good, too. Anything that reminds plan members, like a postcard sent to the home, helps.
Making it free is huge. There’s a big debate about whether telemedicine falls into the health savings account (HSA) rules for high-deductible health plans (HDHPs). Under those rules, the visit could not be free until the participant meets his or her deductible. But some employers argue that telemedicine plans are not part of the health plan and not subject to those rules.
Notably, the Coronavirus Aid, Relief, and Economic Security (CARES) Act created a temporary safe harbor allowing HDHPs to cover telehealth services at no cost to plan members before the deductible is met and therefore individuals remain eligible to contribute to their HSAs. The safe harbor covers services retroactive to January 1, 2020 and applies to plan years on or before December 31, 2021.
If a non-HDHP plan wants to charge a copay, a range of $5-$20 may be an appropriate amount.
Do you expect COVID-19 to have a lasting impact on telemedicine?
Telemedicine is just exploding. Employers that haven’t used it before are making changes pretty quickly to get people connected remotely because most people, if they’re healthy, don’t want to go into any type of health care office for fear that there are sick people there. They only want to talk remotely.
A vendor I talked to said only one in ten calls was about COVID-19. Ninety percent of the calls coming in are non-COVID in nature—people thinking that they might need care but not wanting to go into an actual office.
The impact is going to be long-lasting. I think COVID-19 has encouraged more people to use telemedicine. They like it. They see that it’s a much lower cost and that it’s more convenient than going in to see their doctor. They’re going to get hooked pretty quickly.
Learn More About How COVID-19 Is Changing Employee Benefits
Employee Benefits in a COVID-19 World provides data on a variety of benefits including health care, prescription drug, mental health and short-term disability, as well as retirement plans.
Visit the International Foundation Coronavirus (COVID-19) Resources page to find even more resources for plan sponsors, including these upcoming free member webcasts:
- Current Accounting and Auditing Issues in Employee Benefit Plans | May 27, 2020
- Governance and Oversight Issues for Multiemployer Plan Sponsors During the Pandemic | May 27, 2020
- Common-Sense Investment Approaches to New Economic Realities | June 2, 2020
- Building High-Performing Remote Work Teams | June 3, 2020
Kathy Bergstrom, CEBS
Senior Editor, Publications at the International Foundation of Employee Benefit Plans
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