8 Important Questions to ask about Telemedicine benefits.

Telemedicine Works: But how do I know it will help me?

As a business owner or an employee, there is considerable confusion as to how to gain the most powerful cost savings potential of a telehealth benefit program. There is considerable discussion about what "utilization rate" I can expect if I adopt a plan. The truth is that while a telehealth program can be highly effective in the fight against rising claims and premium costs, it is only effective if you choose the correct partner and solution for your needs.

A challenge can exist as a decision maker on how best to find the correct telehealth solution that best fits your needs. To help make this decision, there are eight simple questions you should ask:

1. What is in it for me?

To answer this question, you have to start by determining your individual or business goals. Some of these might be:

  • Gaining cost savings by redirecting care away from your regular health plan thereby reducing the operational costs of your health plan.

  • Providing improved medical care access so you can provide the conduit to decrease medical related absenteeism as well as presenteeism.

  • Provide a 21st century benefit program to help you compete for the top talent in the employee marketplace.

  • Improving morale of your employees: Provide a pathway to overcome some of the additional costs of healthcare that have been passed to them for not only premiums but with increased out of pocket expenses, co-pays and deductibles for not only the employee but their family members.

  • Help those employees that are not on your group health plan and have to purchase health insurance on an individual basis.

2. Can telemedicine help me reach my goals?

OK. You have set your goals, or several of them. Depending on what those goals are will determine if they can be realized. If they include some or all of those included in the list above, they can be reached over time but only through the utilization of the program.

Telemedicine utilization rates a very dependent of three aspects:

  • Quality of the experience

  • Plan design

  • Employee Awareness

Culturally we have become accustomed to and dependent on the healthcare system as we have seen over the past few years. Unfortunately, that system is dependent on a system where you can only get care on the doctors schedule rather than on your own schedule. Less than half of Americans know about telemedicine. Less than a quarter of them have actually used it. Unless there is a concerted effort to keep TOP OF MIND AWARENESS of the program by helping each of us break that cultural habit with the use of the healthcare system. We are attached to what we know. So unless we are educated on the program and how it can benefit each of us, the program will not achieve the results desire.

3. What type of plan is best for me?

As an industry, telemedicine is a relatively new.. The most prominent plans available are broken down into:

Doctor supported plans, where contact is made directly with a doctor or,

Nurse supported plans, where the contact is made with a nurse who consults with a doctor if needed.

Although there may be a place and time that a nurse supported program may help, in most cases, the best programs include the ability to talk directly with a US based licensed physician.

Currently there are a few different business models offered by the Telemedicine Industry. They are:

  • Per Employee Per Month (PEPM) model with a Consultation charge for a visit with a doctor.

  • No monthly charge (no PEPM) model with a consultation charge for a visit with a doctor.

  • Per Employee per Month (PEPM) with NO consultation charge for a visit with a doctor.

"So what is best for me?" It can only be answered definitively when your goals are reviewed. But in most cases, the best plan is the one that obtains the best utilization. The best utilization can only be achieved when there is a strong education program to change the culture and a program that provides the least resistance to use, which is a plan with no consultation charge.

4. When can the plan be implemented?

Plans can be implemented at any time. There is no need to wait for "open enrollment". In fact, it may be better to implement the program at a time other than open enrollment so that the telehealth program can get the full attention of those members that enroll.

5. Does the plan cover the entire family?

Make sure that it does. It is very important that the entire family is covered so that full maximization of the benefits can be achieved. The biggest benefit received from the program is the ability to use the program for all in the household. For many of us, having the coverage for the kids is more important than the coverage received for adults.

6. What can or will you do to help us with maximizing our utilization of the program?

This program must be marketed to your members or employees. Make sure that whomever is providing the telehealth program can help you with driving utilization. In order to change the current healthcare usage culture, members must be continually reminded of the existence of the program and the benefits that can be received.

Any telehealth program without utilization will not achieve any of the goals listed above. The best telehealth programs will not work properly without a method to change the culture through education and reminders that will help change the current culture of our existing healthcare systems. These programs are designed to be used.

7. Does the plan have a consultation charge?

It really is simple, in order to achieve the most utilization of telehealth, the program needs to be designed to offer the least resistance to it's use. If there is a consultation cost to the user, it creates another barrier. It is well documented by the major telehealth companies, that the best utilization rates are achieved when there is no cost to the user. Some telehealth companies that do have consultation charges will often suggest that the company offering the program absorb the consultation charge and present it to their employees as a "zero consultation" program. This is great for the user, but slows the progress of achieving some of the goals listed above. The best programs will have "zero consultation charges" to the user without the sponsoring company paying all or a portion of the consultation charge.

8. Isn't it easier to have a telemedicine program built into my regular health insurance plan?

Again, this depends on what you are trying to achieve through the implementation of a telemedicine program. It may be slightly easier to manage administratively but don't lose sight of your goals for the implementation of the program in the first place.

With an estimated 70% of all employees at large firms with access to telemedicine programs, only 3% of these employees used the service. Why? Because the program is embedded in a large health insurance program offering. Many times the embedded telemedicine benefit is only for the person insured. If you do not have your entire family on the plan, you may not have telemedicine coverage for the entire family.

For the most part, the insurance company, the employer and in some cases the employee, do not want to use their health insurance benefit. It costs more money. As a result, there is not any active program to help people understand or encourage their use.

With the correct partner, a stand-alone telemedicine provider will provide a continued education and reminder system to keep the program in front of the employee. Driving utilization of the program. Helping you achieve your goals for implementing the program.




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