Unmasking Virtual Medicine

I had a conversation with my brother this week. Both of our families are in the swarm of the cold and flu season. (Currently, my voice enjoys a Barry White congestion-induced baritone.) In the course of our conversation, my brother shared an “unbelievable” (his words) experience with their health insurance. His wife found out she can call and speak to a doctor on the phone! She calls the doctor; he listens to her cough over the phone, and then prescribes some medication that she can pick up. My brother was blown away and asked me if I knew about this kind of service. My reaction….YES OF COURSE! I go on to explain that telemedicine is not new, it’s just not known. It’s hidden, masked, and not by accident, but on purpose. 

The reality is, virtual medicine has been around in some form, for decades; over 20 years ago, I started my healthcare career as a behavioral health tele-counselor. Today, virtual medicine is on the rise as new solutions enter the healthcare arena with video, chat, phone, Facetime, etc. With the employers and employees feeling the pain of healthcare cost, lower cost and more convenient delivery forms are gaining more attention and emphasis. Seems like a no-brainer, given our “smart phone technology comfortable” society, that virtual medicine would take hold. But, it has not. A recent report that I read states that only about 8% of employees that are offered telemedicine, actually use it.  Why is this?

The answer is multi-faceted. Here are the three key reasons that I have seen:

1.     Because it is designed, promoted, and priced to be a low-utilized commodity. As I mentioned earlier, I started my career as BH counselor over the phone. I worked at a National EAP (Employee Assistance Program) organization that offered employer paid telephonic counseling to employees and their family. No one will contest the huge role behavioral health plays in a person’s ability to overcome physical, emotional, and social challenges/conditions; nor the prevalence of mental health issues. And yet, EAP utilization hovers around 5% on average. The reason is that the services were priced based on the expected utilization. If priced low, the services were “hidden” or embedded into the overall plan design and were not actively promoted. In short, while the services were impactful, they were designed not to impact many. The old adage, you get what you paid for, rang true. 

This same dynamic happens with any plan design and service, and certainly those with non-traditional services like Virtual Medicine. You design and promote your plan to steer people to the kind of care you want them to utilize. Large insurance carriers understand this and their main stakeholders are healthcare providers. Supplying volume (i.e. revenue) to these providers is foundational to the relationship, and designing a plan that cuts dramatically into that arrangement would not be ideal. Thus, virtual medicine is masked and hidden into the over plan and promotion. This explains my brother’s reaction: “Can you believe that?!”

2.     Old habits are hard to break. When you get sick, what do you do? You go to the doctor. That’s what you do. No industry, for better or worse, is more behaviorally engrained in consumers than healthcare. We grew up going to the doctor’s office and this habit continues today even if an alternative that may be more appropriate, and more convenient, with the exact same outcome is available. The challenge with any innovation or service is breaking old patterns. There are certainly situations where a face to face interaction with your doctor is not only preferred, but recommended. With that said, the role of virtual medicine in complementing, and in some cases, replacing the old habit of “going to the doctor”, has to be harnessed. How does this happen? More education across the board with consumers and business owners that these options exist and need to be communicated effectively and consistently to their employees and their families.  Employees need to request that their employer include virtual medicine options in their benefit plan. Employers need to leverage their buying power and push their advisors and carriers to design plans that encourage consumers to consider new habits. The reality is that most who step out and try virtual medicine, love it. They love the convenience and they love how it benefits their pocketbook. Not to mention that they feel cared for in a way that empowers them in the process, making them better and more informed consumers.

3.     The rise of healthcare costs. You think this would be a reason for virtual medicine to grow in popularity but the opposite seems to happen. Because premiums and medical spend continue to rise, employers’ healthcare $$ are stretched thin and thus an “add-on” like a robust, aggressively promoted telemedicine option seems to fall by the way side. The irony, it’s this kind of service option that could help lower cost if positioned appropriately. It is not the end all be all, but should be considered in plan design strategy discussions. This applies to many other alternative design options available to employers today. I view some “add-ons” as foundational to plan designs of the future.

So, what is our call to action as healthcare professionals? This depends on the role you play in healthcare industry. I work at CWI Benefits, an independent TPA (Third Party Administrator). Our role is to work with advisors and plan sponsors, administering various benefit plan designs – adjudicating claims accurately, managing enrollment and eligibility, care management, utilization management, etc. This gives us a real-world and real time view of the plan designs employers are offering, as well as the solutions in the market to tackle unnecessary costs. We see an opportunity in the market to challenge the “old way” status quo of healthcare by offering and administering cost containment solutions in a new way. That’s our call to action. It is time to “unmask” virtual medicine and other non-traditional approaches of care solutions.