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By: Barry McNamara

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May 22nd, 2015

What is Telemedicine, and is it Right for Our Organization? (Part 2)

Healthcare

Driven by the convergence of ever-improving technology, healthcare cost drivers, consumer preference and provider/patient convenience, telemedicine is booming business. Some readers of this post may have been early adopters. Others may be wondering…Exactly what is telemedicine? How does it work? What are the opportunities for -- and the obstacles to – adoption for our employee benefit program?

This is the second of a two-part post (Read Part 1). In this post, we’ll focus on the last question.

is telemedicine right for me

So is telemedicine right for my organization?

If your goal is to increase employee engagement, productivity and satisfaction, absolutely! Regardless of size, location, industry, etc., all signs point to e-visits being a BIG hit with employees.

If you also want to reduce plan costs, the answer will depend on three primary factors: your funding arrangement, who provides the telemedicine service and the percentage of employee adoption.

  • If your plans are community rated and your carrier offers e-visits, even universal adoption by your employees will not help lower the rates that you pay.

Sure, your employees will like the benefit, the convenience and the lower copay, but the premium ‘needle’ won’t move until and unless there’s universal adoption of telemedicine across the entire community pool.  

  • If the carrier providing your community rated plans doesn’t offer e-visits, you’ll have to engage a third-party telemedicine firm. They’ll charge you a fee for the service, and that will increase your costs.

So -- again -- good for employee relations, but no help on the cost side.

  • If your plans are either fully insured/experience rated or self-insured -- where your premium rates are largely, or totally, determined based on your own claims utilization -- you should definitely consider adding e-visits to your plan designs.

In this scenario, vendor selection starts with your current carrier/TPA. Typically, there won’t be an additional fee for this service, and -- even better -- the cost of an e-visit that is charged to the plan will be much lower than the cost of a routine office visit, and significantly lower than the charge for an Urgent Care or Emergency Room visit.

What is telemedicine

How do I select a Third Party Telemedicine Firm?

If your carrier/TPA doesn’t offer e-visits, you’ll have a number of large and experienced telemedicine firms to pick from. Their models will differ, so you’ll have some analysis to do:

  • total providers – and what types – in their ‘network’
  • training of non-clinical service reps
  • billing arrangements -- fixed fee per visit; per contract per month; per member per month, etc.
  • performance measurements – average speed of answer, average physician call-back time, etc.
  • the support services and materials they will provide to get – and keep! – your employees engaged, etc.

Especially if you’re self-insured, you might also consider looking at the third-party firms even if your current carrier/TPA does offer e-visit capabilities. Competition for your business is good -- for you! At the least, you’ll have looked under all the rocks. At best, you could end up with an arrangement that’s more robust and better for you financially that the first offers tendered.

Related Blog: The Pros and Cons of In-House Affordable Care Act Compliance

Bottom line…telemedicine is here to stay, and the savings are for real. If you decide to move ahead -- regardless of who you choose to provide the service -- make sure you get ‘baseline’ data first (the number of visits, by setting and type, that occurred over the last 12 to 24 months). You’ll need that to estimate your savings and to measure the telemedicine vendor’s success in helping you engage your employees and control your healthcare costs.

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Mistakes are expensive, especially when building benefit plans.

We've outlined the 3 most common mistakes employers make when offering benefits in a quick ebook. Get your copy free when you subscribe to our blog.