Doctor, Can you Heal me Now? 

Creating Value and Savings by using Telemedicine to 

Improve the Patient Member Experience 

“Careington’s telemed solutions give you valuable, affordable options  to manage costs– a must in today’s volatile health care environment.” 

Prepared by 

Mark Roberts Manager of National Accounts 

 Confidential and Proprietary 7400 Gaylord Parkway | Frisco, TX 75034 | (800) 441‐0380 x2905 markr@careington.com  www.careington.com 

 

 

Telemedicine is Popular

Telemedicine is booming, as companies and other organizations look for ways to reduce health care costs.

Telemedicine involves the practice of medicine using two-way video, email, smart phones, and other telecommunications tools. It started out more than 40 years ago with hospitals extending care to patients in remote areas and has spread fast, now being used in hospitals, primary doctor's offices and by specialists and home health agencies, as well as consumer’s homes and workplaces.

Benefits to employers include not having to reimburse a doctor for the expense of an office visit and not having employees spend half of a work day waiting to talk to a physician to get a prescription for a relatively simple health issue, such as a sore throat or the flu. Patients like it because the service is sometimes free to them, or they may incur a small consult fee. Either way, the patient saves money and time.(1)

Telemedicine is one of the fastest growing trends in health care. 

The ability for consumers to address medical issues telephonically with a physician is a huge savings in time and money for not only individuals and families, but also for employers. The concept is not new, but the acceptance factor over the past couple of years continues to increase dramatically as more and more people want to talk with a doctor without having to wait in an office or clinic for hours on end until the physician has time to see them.

 

 

Of all the problems with the U.S. health-care system, one of the most vexing for patients is simply sitting in the doctor's waiting room. Being ushered into the exam room, only to be left shivering in a paper gown, to wait some more, adds to the aggravation. It's the health-care equivalent of being stuck on the tarmac in a crowded plane, according to the Wall Street Journal.

The average wait time once you get an appointment is 22 minutes, and some waits stretch for hours, published in a 2009 report by Press Ganey Associates, a health-care consulting firm, which surveyed 2.4 million patients at more than 10,000 locations. Orthopedists have the longest waits, at 29 minutes; dermatologists the shortest, at 20. The report also noted that patient satisfaction dropped significantly with each five minutes of waiting time.

Average Physician Wait Times by Region

Now, imagine if you live in Massachusetts. If you thought the wait time to see a doctor was getting longer, you’re right. The latest survey from the Massachusetts Medical Society (MMS) shows that finding an appointment in six of seven specialties is either harder this year or no better than last. If you’re a new patient and want to see a family physician, about half of all practices aren’t

 

 

taking anyone new. If you have a public insurance plan, such as Medicare and Medicaid, then you may have some additional trouble receiving care.

The report has serious implications for health care costs in the state, according to the MMS, because patients unable to see a primary care physician are likely to seek more expensive emergency room treatment. Even for patients fortunate enough to have a primary care doctor, waits for appointments continued to be lengthy. The average wait for an appointment with an internist was 48 days, which was five days shorter than last year, but the average wait for family medicine was 36 days.

Health insurance is usually tied to jobs in the United States. When unemployment goes up, so does the amount of uninsured people. Employees who are laid off can be offered Cobra insurance, but the rate is often prohibitive. Scared and stressed, many people do not know where to turn, according to Sell Write Now. Telemedicine is the blend of healthcare and technology. Thanks to technology, people now have the choice to consult with a doctor online or over the phone in the comfort of their own home or office.

Not only is a less stressed patient a better patient, but there's also cost savings on gas and parking fees. Many people want to forgo the entire hassle of visiting a doctor, and are opting to do it online or via a phone call with a physician. Seventy percent of non-emergency care can be performed this way. Utilizing telemedicine cuts down on clogging emergency rooms and the risk of catching something in a waiting room. It is also convenient for parents who won't have to find child care, or gamble getting their child sick by bringing them to the doctor's office.

 

 

Once a fanciful notion limited to science fiction films, "virtual visits" with health care providers have gone mainstream. Lawmakers, medical professionals and insurance carriers looking for ways to improve health care services and cut costs are turning to "telemedicine," medical consultations offered by phone or electronic communications, such as email and live video, according to TMCNet. As moreemployers and private insurers adopt similar policies, the market for telemedicine services in the U.S. is expected to generate $3.6 billion in annual revenue over the next five years, according to a study by research firm Pike & Fischer. The growth of telemedicine is only expected to increase, particularly as PPACA legislation goes into effect in 2014.

As an employer, how do you take advantage of telemedicine for your employees? There are several vendors, but three of the best in the industry are TelaDoc, AmeriDoc, and CallMD. Based on the model provided to the employer, patients who use this product call a toll free number and talk with a medically trained rep who completes a health profile and triage the call to determine the type of medical issue at hand. If the caller is not suffering from an emergency, a return call is scheduled within three hours or less by a physician in the state where the resident is at the time of the call. Patients with critical calls are referred to emergency rooms or to call 911.

Physicians diagnose the medical need, and if necessary, prescribe a medication for the caller to pick up at a local pharmacy. Telemedicine calls are usually “one and done”, with the majority of issues satisfied by the physician. Doctors cannot prescribe DEA controlled substances or narcotics. They also recommend other

 

 

courses of action if the caller has medical issues not readily diagnosed by phone, and a follow up call is made within a timely basis to check on the prognosis of the patient. A recommendation is also usually made that the patient visit a primary care physician if there are any other immediate or long term health care needs.

"The average emergency room visit costs about $1200, but research indicates that most ER visits are non-emergencies," notes David Lindsey, CEO of Ameridoc. "Most doctors' office visits are unnecessary, too, because the patient just wants a second opinion, or they have a common condition." Using telemedicine services, such as those offered by AmeriDoc, patients don't have to wait for an appointment, and they can avoid having to take time off work or school to see a doctor. The cost is far lower – usually under $40 for a phone consultation in some cases, versus about $150 for an office visit to a general practitioner - and the option to have a "virtual doctor visit" also improves the availability of health care in rural areas.

If you want to save money as an employer, especially if your company is self funded for medical claims, then it makes perfect sense to bring on telemedicine. Your employees will use it to save time and money, and your CFO will love you for it. Telemedicine is here to stay. Use it, and increase your bottom line. (2)

Telemedicine makes a difference in Long Term Care

Telemedicine can help keep nursing home residents out of the hospital and reduce health care costs, according to a study in the February issue of Health Affairs. But these outcomes won’t become widespread unless a strong business case for telemedicine convinces nursing homes to invest in it.

Researchers from Harvard and Dartmouth universities used funds from the Commonwealth Fund to study 11 nursing homes that belong to a for-profit nursing home chain in Massachusetts. The chain contracted with a telemedicine provider to cover urgent or emergent calls on weeknights and weekends.

A medical secretary at the telemedicine service answered the after-hours calls and referred residents to a staff nurse, nurse practitioner or physician. Clinicians used 2-way video conferencing and a high-resolution camera to examine residents and prescribe treatments.

 

 

Researchers compared 2 years of outcomes from 6 nursing homes that used the telemedicine service and 5 nursing homes that did not. They also categorized nursing homes in the intervention group as “more engaged” or “less engaged,” depending on how often they used the telemedicine service.

Engaged Nursing Homes Reduce Hospitalizations

Hospitalization rates dropped by 9.7% among nursing homes in the intervention group after the telemedicine service began. Nursing homes in the control group reduced their hospitalization rates by 5.3%.

Researchers did not consider this difference in hospitalization rates as statistically significant, according to Medical Xpress. But they were impressed with the 11.3% decline in hospitalization rates at “more engaged” nursing homes in the intervention group.

Researchers projected that nursing homes that were “more engaged” with telemedicine could each save Medicare an average of $151,000 each year. Each telemedicine system costs $30,000 to install.

How to Encourage Telemedicine Engagement

Making sure that nursing homes are fully engaged with telemedicine is the key to achieving reductions in hospital use, said the researchers. But that engagement could be difficult to achieve.

First, say researchers, telemedicine providers and nursing home leaders must work hard to get buy-in for telemedicine from nursing home administrators, front-line workers and physicians.

Second, policy makers must remove current disincentives to telemedicine engagement among nursing homes. For example:

Nursing homes must pay for a telemedicine service, but Medicare enjoys the savings that result from the service.

Nursing homes earn higher reimbursements from Medicaid if a resident is sent to the hospital and then returns to the nursing home.

New payment models like accountable care organizations and managed care plans could spur nursing homes to use telemedicine to reduce hospital use by residents. Until these payment models become more widespread, however, “we do not believe that the business case for telemedicine services in nursing homes is a strong one,” say researchers.

 

 

However, the need is great to reduce the cost of care, especially in nursing home environments. (3)

Telemedicine has more Positives than Negatives

To be sure, there are a lot things telemedicine can’t do, from prescribing opiates to setting a broken bone or biopsying a suspicious lump. But for antibiotics, lower-strength pain medications, antihistamines, basic dermatology, forgotten medication, and questions about whether an in-person doctor’s appointment is warranted, a doctor who is available by voice, FaceTime, or Skype can be just the ticket.

Other potential telemedicine clients include anyone who’s away from home, whether traveling, working, or going to school; college-age adults who have graduated from a pediatrician’s care but don’t yet have an adult primary care doctor; people who work in the wilderness; individuals who are used to technology driving simple, immediate solutions; and anyone who can’t easily take time away from work to visit a doctor.

 

 

A lot of people share an enthusiasm for telemedicine, it seems. According to a report from the Wellesley, Mass.-based market research firm BCC Research, the telemedicine market was worth an estimated $11.6 billion in 2011, up from $9.8 billion in 2009. Over the next five years, the market’s compound annual growth will reach an estimated 18.6 percent, with the telehospital and teleclinic segments estimated to grow at 16.8 percent during that time period.  

Telemedicine also can increase worker productivity, because an employee doesn’t need to take half a day or more in sick time in order to deal with a medical issue. Because telemedicine offers immediate access to medical professionals, workers aren’t chained to their desks all afternoon, afraid to attend a meeting because they’re waiting for a doctor to return their telephone calls.

A lack of pay makes returning patient calls a low priority for many doctors. Others are simply overwhelmed by patient needs. According to a Nov. 7, 2013, article in the Wall Street Journal, only about 20 percent of medical students choose primary care specialties—pediatrics, internal medicine, and family medicine—as their focus.

That leaves too few primary care doctors taking care of too many people already, and the problem is only getting worse. Millions of formerly uninsured patients will buy insurance through the exchanges under the Patient Protection and Affordable Care Act, and 10,000 people will turn 65 every day for the next two decades. By 2020, the Association of American Medical Colleges predicts, the U.S. will be short 45,000 primary care doctors.

 

 

By most accounts, telemedicine is rising in popularity among employers and health care executives—and now it looks like consumers worldwide are receptive to the recent trend. According to an Intel survey, 72 percent of consumers say they are willing to see a doctor via telehealth video conferencing for non-urgent appointments. And half say they would trust a diagnosis delivered via video conference from their doctor.

This and other findings from Intel reveal that consumers are optimistic about health care in terms of technology and innovation. Some consumers are so optimistic about technology, in fact, that more than half believe the traditional hospital will become obsolete in the future. These survey results indicate a “very high willingness of people to become part of the solution to the world’s health care problems with the aid of all sorts of technologies.” (4)

What Services Can Be Provided By Telemedicine?

Sometimes telemedicine is best understood in terms of the services provided and the mechanisms used to provide those services. Here are some examples:

Primary care and specialist referral services may involve a primary care or allied health professional providing a consultation with a patient or a specialist assisting the primary care physician in rendering a diagnosis. This may involve the use of live interactive video or the use of store and forward transmission of diagnostic images, vital signs and/or video clips along with patient data for later review.

Remote patient monitoring, including home telehealth, uses devices to remotely collect and send data to a home health agency or a remote diagnostic testing facility (RDTF) for interpretation. Such applications might include a specific vital sign, such as blood glucose or heart ECG or a variety of indicators for homebound patients. Such services can be used to supplement the use of visiting nurses.

Consumer medical and health information includes the use of the Internet and wireless devices for consumers to obtain specialized health information and on-line discussion groups to provide peer-to-peer support.

Medical education provides continuing medical education credits for health professionals and special medical education seminars for targeted groups in remote locations.

 

 

What Delivery Mechanisms Can Be Used?

Networked programs link tertiary care hospitals and clinics with outlying clinics and community health centers in rural or suburban areas. The links may use dedicated high-speed lines or the Internet for telecommunication links between sites. ATA estimates the number of existing telemedicine networks in the United States at roughly 200 providing connectivity to over 3,000 sites.

Point-to-point connections using private high speed networks are used by hospitals and clinics that deliver services directly or outsource specialty services to independent medical service providers. Such outsourced services include radiology, stroke assessment, mental health and intensive care services.

Monitoring center links are used for cardiac, pulmonary or fetal monitoring, home care and related services that provide care to patients in the home. Often normal land-line or wireless connections are used to communicate directly between the patient and the center although some systems use the Internet.

Web-based e-health patient service sites provide direct consumer outreach

and services over the Internet. Under telemedicine, these include those sites that provide direct patient care.

 

 

What Are the Benefits of Telemedicine?

Telemedicine has been growing rapidly because it offers four fundamental benefits:

Improved Access – For over 40 years, telemedicine has been used to bring healthcare services to patients in distant locations. Not only does telemedicine improve access to patients but it also allows physicians and health facilities to expand their reach, beyond their own offices. Given the provider shortages throughout the world--in both rural and urban areas--telemedicine has a unique capacity to increase service to millions of new patients.

Cost Efficiencies – Reducing or containing the cost of healthcare is one of the most important reasons for funding and adopting telehealth technologies. Telemedicine has been shown to reduce the cost of healthcare and increase efficiency through better management of chronic diseases, shared health professional staffing, reduced travel times, and fewer or shorter hospital stays.

Improved Quality – Studies have consistently shown that the quality of healthcare services delivered via telemedicine are as good those given in traditional in-person consultations. In some specialties, particularly in mental health and ICU care, telemedicine delivers a superior product, with greater outcomes and patient satisfaction.

Patient Demand – Consumers want telemedicine. The greatest impact of telemedicine is on the patient, their family and their community. Using telemedicine technologies reduces travel time and related stresses for the patient.

Over the past 15 years study after study has documented patient

satisfaction and support for telemedical services. Such services offer patients the access to providers that might not be available otherwise, as well as medical services without the need to travel long distances. (5)

 

 

Why use Telemedicine?

Remote healthcare services and technology are quickly becoming commonplace for healthcare organizations across the globe. Telemedicine enables practitioners to evaluate, diagnose and treat patients remotely using the latest telecommunications technology. In many situations, telemedicine offers numerous benefits as an alternative to traditional in-person medical care, including:

Many patients find it difficult to travel to clinics, hospitals, or doctors’ offices for any number of reasons. Telemedicine can be a great option for patients with unique challenges or in situations making it difficult to travel to receive traditional care.

By using video conferencing and other telemedicine technology when applicable, healthcare practitioners and patients can reduce the costs associated with regular office visits.

Remote medical technology is an increasingly popular way to administer preventive medicine and manage chronic conditions.

Telemedicine can be used to monitor discharged patients and track patient recovery, facilitating communication between doctors and patients.

 

 

Research shows that the use of telehealth technologies results in many positive outcomes including fewer hospital re-admissions, more faithful following of prescribed courses of treatment, and faster recovery than that of patients not receiving remote intervention.

Telemedicine allows hospitals to create networks to provide each other with support. By easily sharing their expertise outside their own institutions, doctors can offer incredible value to their medical colleagues and those colleagues’ patients.

These are just a few of the benefits that can be realized from the use of telemedicine. (6)

Experience makes the Difference  

Careington and our product vendors provide experiential data concerning their respective wellness services and products, including telemedicine options. : Organization and strategy of benefits Employee health improvement Savings in time and money for employer and employees Provider engagement with employee is fast and efficient Member engagement with provider is highly satisfactory Data and reporting for utilization available

Each time the provider interfaces with a member, there is an opportunity to impact the accuracy of each member’s health care burden, improve adherence to evidence based medicine and preventive health options, and increase access and utilization of physician concierge services.

Call the telemed service: When your physician is not

available After normal hours of operation For non-emergency care When you are on travel

 

 

You can use telemedicine for non-emergency medical issues such as:

Cold or Flu Sinus Infections Allergies Respiratory Infections Bronchitis Pink Eye Urinary Tract Infections Poison Ivy

Careington’s Telemed Solution  Designed to increase member engagement and close clinical gaps, Careington’s performance-driven telemedicine solution can help you: Optimize employee health maintenance Maximize your members’ health care experience Save money and time from employee absenteeism Elevate employee retention and acquisition

Telemedicine vendors under contract offer a national network of U.S. board-certified, and state-licensed physicians who use electronic health records, telephonic consultations and online video consultations to diagnose conditions, recommend treatment and write short-term, non-DEA controlled prescriptions when medically appropriate. Physicians are available 24 hours a day, 365 days a year, allowing you and your family convenient access to quality care from home, work, or on-the-go as opposed to more expensive and time consuming alternatives like the doctor’s office or emergency room. Telemedicine through Careington provides access to physician care around the clock--providing peace of mind to consumers, employers, and employees.

 

 

  

Bibliography 1.) http://www.bizjournals.com/dallas/blog/2013/10/telemedicine‐is‐hot‐careington.html?page=all  

2.) http://www.benefitspro.com/2011/09/06/the‐doctor‐will‐hear‐you‐now  

3.) http://www.leadingage.org/Can_Telemedicine_Keep_Nursing_Home_Residents_Out_of_the_Hospit

al.aspx  

4.) http://www.benefitspro.com/2014/01/01/the‐rise‐of‐telemedicine  

5.) http://www.americantelemed.org/about‐telemedicine/what‐is‐telemedicine  

6.) http://www.globalmed.com/additional‐resources/why‐use‐telemedicine.php  

 

 

 

 

 

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Mark Roberts Manager of National Accounts 

Careington International Corporation 7400 Gaylord Parkway | Frisco, TX 75034 

Toll‐Free: (800) 441‐0380  x2905 markr@careington.com www.careington.com