A New Era for Individual Advisors & Business Consultants

DocDial Managing Partners; Steve Dodder & Mel Schlesinger

Telehealth + Health

Advocacy

Mel Schlesinger

What is Telemedicine?

From the American Telemedicine Association:

“Formally defined, telemedicine is the use of medical

information exchanged from one site to another via

electronic communications to improve a patient’s

clinical health status. Telemedicine includes a

growing variety of applications and services using

two-way video, email, smart phones, wireless tools

and other forms of telecommunications technology.”

http://www.americantelemed.org/about-telemedicine/what-is-telemedicine#.VP-qNuEi_nQ

Mel Schlesinger

How do Consumers Become Engaged With

the Use of Telemedicine / Health?

From their Physicians office or healthcare clinic

From a local or regional hospital

From a provider, such as TelaDoc, E-Telemed, MD Live

Via their health insurance carrier

You, their Health Insurance Advisor

To Individuals and their families

To any size businesses on an employer-pay-all or voluntary basis

Associations

Not-for-profitsMel Schlesinger

2 Models of Advisor Delivered Telemedicine / Health…

a) No charge to the consumer/ patient until the telemedicine

connection is made, then pays a copayment (i.e. $30-$50)

per electronic consultation. Similar to a standard physical

office visit copay.

b) Consumer/patient pays a recurring monthly fee (credit

card, list bill or employer pay all). Typical fees range from

$9.95 for telemedicine only to $29.95 pmpm for a bundled

telehealth program for an entire family with unlimited

consults per month.

Telemedicine / Telehealth is in 48 states and The D.C. (due

to state laws telemedicine is not available in Idaho & Arkansas)

Mel Schlesinger

Telemedicine: Improving Access, Decreasing Costs

Telehealth improves patients' access to

doctors when they might otherwise face

delays or be unable to reach a physician. It

can allow patients to interact with both

primary care doctors and specialists over

live video, limiting the need for an office

visit.

A 2012 study from Johns Hopkins University concluded that telemedicine didn't just

produce equal clinical outcomes to in-

hospital care but, in some cases, produced

better outcomes.

Costs are much lower with telehealth,

because it removes the need for

transportation…

http://www.ncpa.org/sub/dpd/index.php?Article_ID=25326

Mel Schlesinger

When is Telemedicine appropriate?

…and many other additional conditionsMel Schlesinger

When is Telemedicine Not Appropriate?

The Telemedicine Physician will direct the patient to call 911 or go to nearest ER for

Broken Bones

Cuts

Burns

Heart Attack

Accidents

Mel Schlesinger

How Does it Work?

Mel Schlesinger

Two Individuals

Mel Schlesinger

Telehealth Versus Status Quo

John Jane

Mel Schlesinger

Telehealth Versus Status Quo

John Jane

Mel Schlesinger

Average Telemedicine Savings (graphic)

Projected Growth of

TeleMedicine/Health

Mel Schlesinger

Telemedicine/Health Growth Projections

Forbes contributor Bruce Japsen

recently interviewed an analyst at IHS,

who predicts that the U.S. telehealth market will

grow to $1.9 billion in 2018 from $240 million

today, an annual growth rate of 56 percent. This

is explosive…

Mel Schlesinger

Video consultations to triple by 2015

In 2014, there will be approximately 5.7 million

telemedicine consultations, which is

expected to jump to more than 16 million in

2015. Furthermore, by 2018, the number of

video consultations is projected to surpass

130 million.

http://www.beckershospitalreview.com/healthcare-information-technology/video- consultations-to-triple-by-2015.html

Mel Schlesinger

Wait Times for Physician Office Visits

Mel Schlesinger

Fewer Physicians

81% of physicians describe themselves as either

overextended or at full capacity, up from 75% in

2012 and 76% in 2008. Only 19% say they have time to

see more patients.

44% of physicians plan to take one or more steps that

would reduce patient access to their services, such as cutting back on patients seen, retiring, working part-time, closing their practice

to new patients…

39% of physicians indicate they will accelerate their retirement plans due to

changes in the healthcare system.

2008 2012 2014

0-10 7.4% 19.5% 22.8%

11-20 31.7% 39.8% 35.7%

21-30 41.2% 26.8% 24.6%

31-40 13.6% 8.1% 11.4%

41-50 3.7% 2.6% 2.8%

51-60 0.99% 0.8% 1.4%

61+ 1.23% 2.4% 1.3%

Avg. 23.4% 20.1% 19.5%

On average, how many patients

do you see per day (include both

office and hospital encounters)?

With 30 Million More People Coming Into

the Healthcare System due to ACA

Consider these sobering figures:

Even before health reform, a multitude

of studies warned that the U.S. would

face a shortage of primary care

providers as large as 45,000 by 2025

The shortage will further increase as a

result of the insurance expansion which

will go into effect in 2014. With 30 million

newly-insured individuals seeking care,

at least 52,000 new providers will be

needed by 2025.

Mel Schlesinger

The Impact of Cost

Mel Schlesinger

Cost Still a Barrier Between Americans and Medical Care

In the U.S., 33% have put

off medical treatment

because of cost

More with private

insurance put off

treatment in 2014 than

2013

Mel Schlesinger

Cost Still a Barrier Between Americans and Medical Care

The percentage of Americans

with private health insurance

who report putting off medical

treatment because of cost has

increased from 25% in 2013 to

34% in 2014.

http://www.gallup.com/poll/179774/cost-barrier-americans-medical-care.aspx

Mel Schlesinger

Skipping Care…

Nearly 30% of privately insured, working-age

Americans with deductibles of

at least 5% of their income

had a medical problem but

didn't go to the doctor, the

Commonwealth Fund found.

43% of those with private

insurance said their

deductible was either difficult or impossible to afford.

Mel Schlesinger

Fear of Cost and Avoidance (10/28/14)

http://www.sciohealthanalytics.com/harrispoll

Mel Schlesinger

Health AdvocacyReducing Out of Pocket Liability

Mel Schlesinger

Advocacy (1) The process of actively supporting the cause

of, speaking or writing in favor of, or defending or

interceding on behalf of a person (case advocacy) or

group (class advocacy). Advocacy may include providing

information and tools for self-empowerment in patients’

health and social care, and helping them obtain needed

services.

(2) Action to assure the best possible services for or

intervention in the service system on behalf of an individual

or group.

Segen's Medical Dictionary. © 2012 Farlex, Inc. All rights

reserved.

Mel Schlesinger

Advocacy Models

Medical Bill Saver

Technical Assistance

Health Coaching

Mel Schlesinger

Technical Support

Helps identify the right physicians and hospitals

Identifies treatment options

Helps with second opinions

Assist in decision-making

Mel Schlesinger

Medical Bill Advocacy

Help patients understand the bills

Identifies billing errors

Negotiates the amount owed by the patient with providers

Average Bill Savings = 50% to 60%

Mel Schlesinger

Impact of Higher Deductibles

Mel Schlesinger

Mel Schlesinger

Average 2015 Deductibles for ACA Plans

2/3 of Americans

Enrolled in the

Silver Plans

Individual

Coverage

Family

Coverage

Bronze $5,181 $10,545

Silver $2,927 $6,010

Gold $1,198 $2,626

Platinum $243 $489

Source; March 2015, InsuranceNewsNet Magazine

Mel Schlesinger

Skipping Care…

43% of those with

private insurance

said their

deductible was

either difficult or

impossible to

afford.

Mel Schlesinger

American Saving Statistics

28% - Have zero savings

20% - Cannot pay 3 months of living expenses

43% - Have just enough to cover 3 months of living expenses

Bankrate.com – 2012

Average Median Savings = ZERO (foxbusiness.com 2014 – Kate Rogers)

56% of Adults with Children under 18 have less than $800 in savings

Statisticbrain.com – using 2014 Federal Reserve and Census data

Mel Schlesinger

Medical Bills Vs Insurance Company EOB

Narrow Networks = Unexpected Charges

Challenges

Mel Schlesinger

Better Than Gap Insurance

Mel Schlesinger

GAP Vs Telemedicine+Bill Saver

$3500 GAP Insurance

Cost: $101.84 monthly

Lacks Transparency

Little or no help for urgent care

Lower benefit for outpatient

treatment

Telemedicine+Bill Saver

$19.95 monthly

Creates transparency

No-cost Alternative to urgent care

No distinction between in and

outpatient care

Creates employee engagement

Mel Schlesinger

Making the Business Case for Telemedicine /

Health Advocacy

Mel Schlesinger

Good medicine for small businesses

A case study involving a 150-person trucking company that faced a

17% increase in its health insurance premium.

To ease the pain, the company considered switching to a plan with a

higher deductible. That would have saved $150,000 a year in premiums;

it also would have aggravated their employees who would be forced

to pay a bigger portion of their medical bills from their own pockets.

Enter telemedicine. In 2012 the company paid $120,000 in claims for

“non-emergent” doctor visits (the sniffles and such), including expensive

trips to the ER. According to a recent study by AmeriDoc the firm would

save roughly $65,000 in claims. Cost of the telemedicine plan: $24,000.

As for the employees, they’d get to keep their health benefits while not

wasting productive hours schlepping to a doctor’s office or an ER.

http://www.forbes.com/sites/brettnelson/2013/03/28/a-ray-of-hope-for-affordable-convenient-quality-health-care/

Telemedicine Reduces Employees Group Health

Claims

Telehealth’s savings in claim costs range from $300 per

year for a single employee or more than $1,000 per year

for a family of four.

Rent-A-Center, a national chain of rent-to-own stores

with more than 12,300 employees, has benefited directly

from telemedicine. Of the total number of employees,

6906 participated, saving the company more than $1.2

million over the course of a year.

http://www.theihcc.com/en/communities/health_access_alternatives/telehealth-emerges-in-a-consumer-driven-marketplac_huo61ym9.html

Telemedicine – A Less Expensive Altermative

In a survey of 1,000 U.S. employers, 37 percent said that by 2015

they expect to offer their employees telemedicine consultations

as a low-cost alternative to emergency room or physician office

visits for nonemergency health issues, according to Towers.

Another 34 percent are considering offering telemedicine for

2016 or 2017.

http://www.clinical-innovation.com/topics/mobile-telehealth/telemedicine-could-yield-6b-year-savings

Mel Schlesinger

Telemedicine Reduces Employee

Absenteeism Cost According to Absenteeism: The Bottom-Line Killer, a publication from

workforce Solution Company Circadian, unscheduled absenteeism costs roughly $3,600 per year for each hourly worker and $2,650 each year for salaried employees.

When factoring in the costs saved by redirecting care and keeping the employee at work, we calculate each call to a telehealth doctor will save an employer close to $240.

Americans (employee, spouse & dependents) Make Nearly Four Medical Visits a Year on Average.

http://www.cdc.gov/nchs/pressroom/08newsreleases/visitstodoctor.htm

The numbers are staggering.

http://www.theihcc.com/en/communities/health_access_alternatives/telehealth-emerges-in-a-consumer-driven-marketplac_huo61ym9.html

Millennials

Younger Patients Will Expect Telehealth options

…the young set of patients who have grown up

with Skype, instant messaging services and social

media are more than happy to embrace the

telemed trends as the future of their healthcare.

In fact, many of them would probably prefer it:

the upcoming generation of adult patients in the

U.S. will be more “plugged in” than ever before…

60% of millennials support the use of telehealth

options

71% of millennials would like their doctor to use a

mobile app

http://healthworkscollective.com/abby-norman/293436/top-5-telemed-trends-2015

Tech-Savvy Seniors Want Online Options to

Access Care from Home, Accenture Survey Shows

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Telemedicine improves rural access to healthcare.

Up to 25 percent of U.S. residents reside in

rural areas.

Compared with urban populations, rural

residents generally have higher poverty rates,

have a larger elderly population, tend to be

in poorer health, and have higher uninsured

rates than urban areas.

Correspondingly, rural areas often have fewer

physician practices, hospitals, and other

health delivery resources.

These socioeconomic and health care

challenges place some rural populations at a disadvantage for receiving safe, timely,

effective, equitable, and patient-centered

care…

U.S. Department of Health and Human Services

Health Information Technology

http://www.hrsa.gov/healthit/toolbox/RuralHealthITtoolbox/Introduction/ruralhealth.html

Telemedicine improves rural access to healthcare.

Telemedicine has become an

important part of the strategy to

improve health service delivery in

medically underserved areas

in both rural and urban settings. It

enables remote interactions among

providers and between providers and

patients.

Telemedicine has the potential to

improve rural pediatric care by

increasing access to pediatric

specialists and services.

U.S. Department of Health and Human Services

Health Information Technology

http://www.hrsa.gov/healthit/toolbox/RuralHealthITtoolbox/Introduction/ruralhealth.html

Mel Schlesinger

Telehealth Programs Allow More Rural Seniors to Live at Home

Revolutionary telehealth approaches across the United States are helping senior citizens continue to live independently in their own homes.

In five Midwest states, a research project underway uses advanced telehealth capabilities and motion sensors to track and electronically report residents’ daily vitals and changes in trends.

In Kansas, integrating telehealth with home nursing care and social service supports has decreased hospital and nursing home admissions.

In New York State, short-term home telehealth intervention is helping seniors with chronic diseases manage flare-ups that jeopardize their ability to remain at home.

http://www.raconline.org/rural-monitor/telehealth-programs-rural-seniors/

Conclusion / Questions / Answers

Thank You!!!For follow up questions

Mel Schlesinger

336-310-6564

Email: mel@melschlesinger.com

Mel Schlesinger