More employers are offering telemedicine, but why aren’t workers using it?

Oct. 07--Precious Witherspoon's throat felt increasingly raw and her head began to hurt as the workday wore on.

But Witherspoon, an executive assistant at Chicago-based PowerReviews, didn't want to call in sick the next day and haul herself to a doctor's office to hear what she already suspected -- that she had strep throat.

Instead, she dialed First Stop Health on her drive home from work and described her symptoms to a doctor who sent a prescription to her pharmacy. She paid nothing for the consultation.

"It saved me a lot of extra time and energy," Witherspoon said. She estimates she's used First Stop Health -- offered as a benefit by her employer -- at least half a dozen times over the last year.

Employees wish more of their workers would do the same. This fall, employees in Chicago and across the country might notice their employers touting so-called telemedicine -- in which health care is delivered remotely via phone, video or other technologies -- as they gear up for insurance open enrollment. Telemedicine often is offered in addition to or as part of traditional insurance benefits, and some telemedicine companies bypass employers entirely, offering it directly to consumers.

So far, employees haven't warmed to the idea, either because they don't understand it, don't know it's available or because they're skeptical of getting a doctor's opinion via telephone. Telemedicine accounted for only about 1 million of 1.2 billion outpatient medical visits last year, according to brokerage and consultancy Willis Towers Watson.

About 70 percent of large employers offered telemedicine as a benefit this year, but only 3 percent of employees at those companies used the services in the year's first half, according to a survey of 133 companies, each with at least 5,000 employees, released by the National Business Group on Health.

But companies looking to lower their health care costs and boost worker productivity increasingly are adding it as a benefit. If it catches on broadly with consumers, telemedicine could change the face of health care, altering the relationship between doctors and patients seeking relief from common maladies.

Here's how telemedicine works: A patient requests a consultation either by phone or online. Some companies have agents who take patients' medical histories over the phone before they speak to a doctor, and other companies have patients submit their medical histories online. Patients then wait at least a few minutes for a doctor to contact them. The doctor listens to the patient describe symptoms and asks questions. At that point, the doctor can decide whether to offer a prescription or tell the patient to visit a doctor in person.

The service was just what Tracy Bollinger needed last summer, when one of her daughters became sick while working at an out-of-state camp, Bollinger had her call Chicago-based First Stop, the telemedicine provider offered by her husband's employer. The doctor diagnosed a sinus infection, prescribed an antibiotic and her daughter felt better within a day or two, Bollinger said.

"She didn't have a doctor out there," Bollinger said. "It would have been an emergency room visit for a sinus infection. It's kind of silly to do that."

Many say telemedicine is a win for companies and employees alike. If a worker gets sick with a minor illness when the doctor's office is closed, or if the employee doesn't have a primary care doctor, telemedicine is an alternative to an urgent care facility or emergency room. That can mean less time away from work, and can sometimes save workers, insurers and their employers, cash.

The typical telemedicine visit costs consumers about $40 to $49, a fee that is sometimes covered by employers, said Dr. Allan Khoury, a senior health management consultant for Willis Towers Watson. In contrast, before insurance, a primary care doctor visit for something that could be addressed by telemedicine can cost about $110, an urgent care visit about $150, and an emergency room visit $865, Khoury said.

Insurers might pay for most of those in-person costs, leaving employees with just a copay. Or employees might be stuck with a big chunk, especially if they're on high-deductible plans, which have become increasingly common.

PowerReviews' 140 employees and their family members used the telemedicine benefit 51 times in the first half of this year, saving nearly $6,000 in overall health care costs, said Kira Meinzer, PowerReviews' vice president of human resources.

So given the cost and time savings, why aren't more employees in Chicago and across the country dialing in?

"I think the first challenge is employees often don't know about it," said Lisa Mazur, a partner at law firm McDermott Will & Emery in Chicago who advises providers and technology companies on telehealth services. "They need to be educated on its existence."

Jason Gorevic, CEO of Texas-based Teladoc, a large telehealth provider working with 275 Illinois employers, said his company works with employers to educate their workers through welcome kits, seasonal campaigns and posters in offices, among other things.

Teladoc and Chicago-based First Stop are just two of a number of telemedicine providers across the country, which all have their own models and cost structures. Employers using First Stop Health, for example, pay a monthly fee of $5 per employee and employees get free access to consultations. Companies generally pay Teladoc about $1 a month per employee, depending on the company's size, and employees then pay up to $45 per general medical consultation, or less if their companies choose to cover some or all of that cost.

Most employers that offer telemedicine don't require employees to pay the full consultation fees, instead requiring a copay equal to what they would pay for a primary care doctor visit, Khoury said.

A lack of awareness, though, may not be the only obstacle for companies to overcome. Employees may wonder whether a doctor can accurately diagnose them without seeing them in person.

According to a study published in peer-reviewed journal JAMA Dermatology this year, researchers examining 16 teledermatology services found major diagnoses repeatedly were missed and prescribed treatments were sometimes at odds with existing guidelines.

Dr. Jack Resneck, the study's lead author, said he's enthusiastic about the possibilities of telehealth but interested in making sure that as it expands, it does so in a high-quality way.

He's concerned that telemedicine services offered to employees and other consumers don't always allow patients to choose their doctors. Also, the telemedicine doctors often don't have access to patients' full medical records and aren't in communication with their regular physicians.

"I think we've got lots of examples out there of seeing it done very well and other examples where there's room for improvement," said Resneck, a professor and vice chair of dermatology at the University of California at San Francisco.

The AMA recently released new ethical guidance for doctors participating in telemedicine.

Telemedicine advocates readily admit that such services aren't appropriate for all types of medical issues. People with potentially life-threatening illnesses or injuries still should go to the emergency room, and those with chronic conditions should be monitored by physicians, Khoury said.

Providers also typically don't prescribe controlled substances such as opioid painkillers or many types of sleeping pills. Many don't prescribe so-called lifestyle medications, such as Viagra.

But many services tout the qualifications of their doctors and their usefulness when it comes to treating certain common conditions, such as pink eye, sinus problems and urinary tract infections. All of Teladoc's doctors are board certified and state-licensed with an average of 15 years of clinical experience, Gorevic said. First Stop's doctors are also all state-licensed and most of them are board certified, Opdycke said.

Maria Opdycke, First Stop's chief operating officer, said the company is aiming for an "Uber-like model." Other telemedicine providers might describe themselves similarly. Some of First Stop's doctors have their own practices and take telemedicine calls in their spare time, while others take telemedicine calls full-time.

Gorevic said most of Teladoc's doctors take telemedicine calls in addition to practicing traditionally. Some, for example, are emergency physicians who take calls during their free time, while others are doctors who've taken time off from work to raise children, he said.

Teladoc has helped employees at Prism Healthcare Partners, a Chicago management consulting firm, remain productive while managing their health, said Bridgette Thomas, Prism's director of human resources. Many of Prism's employees travel extensively, so the company decided to give telemedicine a try to help those employees get better care while out of town.

"We're usually gone from home Monday through Thursday, in one to three cities at a time, so trying to (visit) a traditional primary care doctor is next to impossible," said Brad Fetters, Prism managing partner and chief operating officer. Fetters said he's used it on the road, and everyone in his family has used it as well.

Employers hope more workers take advantage of the benefit the same way.

Chicago law firm Gould & Ratner began offering First Stop to its now-87 employees nearly three years ago as a way to better support them while also potentially reducing their time away from work, said Laura Sears, the firm's chief administrative officer.

"If it helps them, I would love for them to make that their first call," Sears said. But, she added, "some people are just more comfortable calling their doctor, and that's fine."

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