The rise of telemedicine

A variety of bills around the country, both pending and final, will allow doctors to practice telemedicine across state lines and requiring carriers reimburse telemedicine services.

Cost controller

On the economic side, Loughlin says, is telemedicine's ability to tamp down the rising cost of health care by allowing consumers to use less face time with doctors. A company that offers workers telemedicine in addition to a standard medical plan, she estimates, might save 25 percent on medical costs. If the company is self-insured, that savings goes directly to the bottom line. If the company is fully covered, that savings likely translates to lower premiums.

Telemedicine saves money, experts say, because physicians charge less for a telephone call than from an in-person visit. About 50 percent of office visits are unnecessary, Spain says.

"The typical family of four goes to a doctor 14 times a year. Eight of those visits could have been handled over the phone. If someone uses telemedicine, even imperfectly, they might avoid four of those visits, at about $100 a piece," Spain says.

When his company road tested its product, "90 percent of the people who called got a reduction in the overall cost of their care, because they downgraded from emergency room to urgent care or didn't need a visit at all," he adds. "Only 10 percent of the calls were people that the teledocs couldn't really help."

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.

"Doctors aren't typically paid for telephone calls, and people work around getting a call back from them," Loughlin says.

A lack of pay makes returning patient calls a low priority for many doctors. Others are simply overwhelmed by patient needs. A typical primary care doctor in Vermont might earn $125,000 a year, Loughlin estimates. In the medical world, that's not a huge salary, so relatively few medical students choose primary care as a career.

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 Affordable Care Act's exchanges, and ten thousand people will turn 65 every day for the next two decades. By 2020, the Association of American Medical Colleges predicts, the United States will be short 45,000 primary care doctors.

Those doctors would have acted as medical advocates, in addition to directly treating patients. Spain says telemedicine can help replace those services, too.

"If someone has a serious crisis and needs help getting information about treatment options, a telecom can give advice about whether that person needs a local provider or a center of excellence. Sometimes the wait can be a while at a center of excellence, and a medical advocate can sometimes cut down on the wait," Spain says.

More than meds

Administrative advocacy is another potential telemedicine service.

"A surprising number of medical bills are wrong, and not in your favor," Spain says. "One of our members was in a car accident and broke her leg. The emergency medical technicians called a helicopter to take her to the hospital, and then she got a $42,000 bill for the helicopter ride. An ambulance would have been both faster and cheaper. So she called the telemedicine service. They did an analysis around whether the helicopter ride was medically necessary, and they got the bill down to less than a tenth of the original amount."

To realize all these benefits, employers, brokers, and providers need to persuade workers to use telemedicine as a first responder. That may not be easy.

"When we started rolling this out to employers and agents, nine of 10 customers had never heard of telehealth. The brokers were familiar with it, but sometimes not in a positive context, as telemedicine used to be sold as a low-cost benefit that hardly anyone used," Spain says. "In one case, we talked to an employer who had telehealth for about 300 employees for three years. In those three years, no one had called."

So First Stop Health uses a different approach. The company sends emails, offers webinars, and issues reminders such as stickers and magnets to dispersed workforces.

"We want our customers' employees to use this," Spain says, adding that his company aims for 20 percent participation—"not the usual 1 percent to 2 percent. If we get 15 percent to 20 percent of employees to use the service at self-funded employers, the investment will be repaid three to four times."

It's still early, Spain emphasizes, but so far about 70 percent of contacted brokers seem interested in selling the benefit. Time will tell how quickly it catches on.