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Are All Telemedicine Companies The Same?

I sit here and I wonder why more are not using telemedicine? There is nothing on the market like it! Wellness programs, onsite clinics, whatever else on top of a health plan you have is fine but they typically do not provide 24/7/365 access to a national network of U.S. board-certified doctors.


Telemedicine is a simple tool, very little paperwork, next to no admin work, and it lowers the number of claims, it is a non-insurance product and I hope it stays that way. So if there is a product that can lower claims, lower cost, lower absenteeism, improve access to care, maintain or improve the quality of care why is there resistance from agents, brokers, consultants offering it and employers implementing it? Telemedicine has been around in some capacity since mankind went to space. It has really gained momentum in the workforce in the past few years and growth expectations are huge for years to come.


I have been in the telemedicine space for 8 years, focusing on employers of all sizes. I have learned a lot, seen a ton, and often been amazed with the growth of the field. To keep things simple, I use the term telemedicine (phone, video consults) as that is what most people are familiar with, even though there are significant differences between telemedicine and telemedicine, and the two are often confused. The easiest way to explain it is that it is on-demand access to doctors via phone or video 24/7/365.


You pick up your phone or tablet, go online and video conference with a licensed physician. Employers are using this more and more as a way to lower health care costs. Your employees don't have to take time off work, sit in traffic, and be in a room full of sick people anymore. When employees use the telemedicine service, they avoid going to more costly settings such as urgent care, doctors’ offices, and worst case the ER, which helps lower your costs. It is not an insurance product, and can be offered anytime of the year.


What I see is a lot of people offering the same stuff with a new twist very few look for solutions outside the box. My fear is that shifting costs away from to the employer to the employee can lead to negative consequences and we are starting to see them. People are avoiding going into the doctor’s office because the out of pocket expense. So what could be a simple illness could develop into something more severe and costlier to the employee and employer. Telemedicine can help offset those fears of cost associated with doctor visits.


The two main models are Fee per use which is where the user pays a certain dollar amount ($30-$60 or more) per consult via phone or video.  Sometimes there is low monthly fee ($1-$2) on top of the consult fee. My opinion is the model is broken there is very low utilization.


Think about it would you want to break out you credit card each time you speak with a doctor?  What if you have to follow up a few days later? It creates barriers to utilization.


The second Per Member/Employee Per Month better known as Zero co-pay. This model has a low cost per month cost $3-10, it covers not only the employee but their immediate family also. It is important to have an unlimited usage option. Many offer a truly unlimited product but some limit the number of consults per month.


A main goal besides improving access to care is lowering costs. If nobody uses the telemedicine program, then it is not meeting one of the main goals. There must be partnership between C-level, the benefits team, and the vendor or re-seller offering the service. Too many times a sales rep will get the sale and dump everything the HR team to figure out. Guess What? These types of implementations rarely work.  There needs to be constant marketing/communication/education year around.


Telemedicine is not something you bring up just at open enrollment


Here is what I know:


TELEMEDICINE FACT 1. Many agents, brokers, benefits directors, decision makers still have no clue how to handle, implement or sell/market telemedicine. Many think all vendors are the same, and look at the cheapest options or the biggest player. With that comes no support, no utilization, no marketing and no education. Most add it as a trend these days, as it's a hot topic. Telemedicine is not something that you mention to employees only once and they will use it. There must be ongoing education, and that is where most fail. It is also not something to just dump on HR and let them figure it out. There needs to be a true partnership between the telemedicine services and the client.


Why employers turn to those that have asked for more money each year and trust them to shop for telemedicine is scary to me. Why would one want to put all their eggs in one basket?


You wouldn't buy a football from a flower shop, would you?


Carriers spread their risk, so should employers. Personally if somebody was charging me more money each year, and had few answers as to why, or few solutions to lower costs, I would not hand them more of my business. Yet that is exactly what many employers are doing.


Why CEO's & CFO's kick telemedicine down to HR is again a surprise. Telemedicine impacts your bottom line. Many in HR are scared to make a decision, and will find any excuse they can not to make decisions. Guess what? There is little to no improvement in your health care costs when that happens. Or they make their choice based on price alone. Worst case, they out-source it to their "trusted advisor" that knows nothing about telemedicine.


TELEMEDICINE FACT 2. There is no such thing as free telemedicine. You may get a free trial but either the costs are bundled in with the increased premiums, the employer is paying, or the employee. You get what you pay for. Some try to pitch it as free, but trust me, one way or another somebody is paying for it.


Insurance companies are trying to sell employers on the fact that they already have telemedicine. Problem is they don't tell them the hidden fact, the employee has a co-pay. Furthermore, the employer has to market to their employees and convince them to use something no one knew they had. All this will do is lead to low utilization and like wellness programs tossed to the wayside.


TELEMEDICINE FACT 3. Many telemedicine vendors have teamed up with carriers to gain a larger market. So an agent with company XYZ company now says they offer telemedicine in your health plan through the carrier. That sounds great!


Here is the catch: with that, the telemedicine consults still count as claims in those circumstances. So it does next to nothing to help you negotiate come renewal season. One purpose of telemedicine is to lower the number of claims so employers have a leg to stand on and negotiate better rates. With us, the telemedicine consults never hit the plan as claims. We are shifting dollars away from the carriers. 


TELEMEDICINE FACT 4. The fee-per-use model is, for the most part, broken. It works for some employers. It seems good to employers because they typically don't pay a thing. The employees that are already stressed about costs of everyday life have yet another thing to pay for. The end result is low utilization.


If direct with a telemedicine vendor, it's well below 10%. If with a carrier, utilization is pathetic at around 1.5%. Who would want to pay $40 for a phone call only to be told call back in a few days if things don't get better? Oh and it will be another $40 for the second call! Typically with this model the vendors or carriers do not educate, market or provide much support. It's a "lets talk at open enrollment and renewals" approach. There must be ongoing education to help increase utilization.


TELEMEDICINE FACT 5. The "unlimited" or better known as "zero co-pay" model includes not only the employee but their family as well. Some vendors play games and offer a low price, but limit the number of consults per month or they only cover the employee. By definition, that's not really unlimited. Utilization is much higher in this model. Even if employee-paid, the employees see value in telemedicine when its provides access to them and their family, and they have truly unlimited consults per month.


Employee-paid utilization is lower than employer-paid though. Most important is that with this model comes ongoing education, marketing, and support. For example we reach out 12 times a year. As I mentioned before, telemedicine is not a "set it and forget it" product. Our average utilization year one is 23% and the goal is 35% for year two.


Finally, telemedicine cannot fix everything for employers. It is however a great first line of defense for acute issues. Telemedicine focuses on lowering costs, claims, future premium increases, improving access to care, improving quality of care, decreasing absenteeism, and increasing presenteeism.


Utilization is crucial for a successful program. Sadly, I see many employers looking at price alone and then they wonder why they have next to no savings. As I said  before, this is very much a product of 'you get what you pay for'. If you want the cheapest program, then you get low utilization, little support, education and marketing. CEO's CFO's should be involved...at least at the beginning stages. This impacts your bottom line. No vendor should leave the burden on the HR teams' shoulders, it is a partnership.


For the most part the better model is the zero co-pay model.


My final thought is instead of going with one vendor because they are larger, publicly traded or have millions in venture capital, look at those that offer the options that fit your business model. One vendor cannot be everything to everyone that is why we have so many insurance choices.


Sometimes the little guys haven't lost sight of what telemedicine is and can do. They also still know how to make it work because they are not trying to impress a board with numbers, rather they are still trying to impress you the client.


As always, thank you for reading! If there is anything I can do to help please feel free to reach out.

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