It may seem like science fiction, but telehealth technology is making real-life strides in curbing consumer health care costs while ensuring convenience and efficiency for patients.
According to the Department of Labor, companies lose approximately 2.8 million workdays a year due to employee injuries and illnesses. Experts hope that the recent implementation of telehealth technology into workplace settings will lower the number of unnecessary sick days or unproductive workdays.
Telemedicine, the precursor for telehealth, has been around for about 20 years and is a technology concept that typically helps connect rural hospitals and centers in areas that lack resources and staff with physicians and medical experts. Telemedicine still exists today to foster communication between health centers.
In the last couple years, partly because the technology had improved and patients were better educated about technology, the industry has seen the development of online care. This system uses telemedicine technology to give consumers, instead of medical providers, access to physician help in any setting, including their homes or workplaces.
"Acquisition of health care services through technology is now initiated or is acquired by the patient in the patient's own setting. You're creating pipes between wherever the physician or provider is and wherever the patient is. That changes the landscape of who is available for care delivery in a pretty remarkable fashion," says Roy Schoenberg, CEO of American Well.
In areas that have been deprived of health care, government subsidies traditionally sent a rotating door of physicians to work a few years in difficult-to-reach, often rural, areas.
Now, explains Schoenberg, "all of these different programs are fusing toward investing in telehealth, because you can completely equalize access to health care for patients who don't live in [large cities] ... It is so important that it's not only [about] the efficiency of health care delivery, it also has a social impact."
By implementing online care, which includes webcam technology seen through a Web browser, as well as audio and secure text chat, "you can tap into that network of services from your home," he adds.
The process makes the health care delivery system more efficient by enabling patients to acquire actual health care services over the Internet. They don't need to schedule a future appointment because delivery can be instantaneous. By logging on, patients can connect with the appropriate type of service provider at any time of day or night.
A lot of health care can effectively be delivered, especially when physicians rely more on discussion and questioning, labs and imaging than on the physical inspection of patients.
Headaches, strep throat, diarrhea, or rashes are issues that can be treated with telehealth, but are typically things that would keep employees out of work. With the cough and cold season upon us, physicians can use medical judgment to determine whether questions about coughs, upper respiratory infections, pink eye or the like require in-person attention. Also, if sickness strikes at 2 a.m. when only the ER is open, telehealth portals provide inexpensive and immediate access.
This is important because patients can get care while they're motivated to do something about it. This could save lives when one considers how significant catching a health issue early can be.
Further, telehealth technology provides access for chronic patients with limited mobility. Homebound patients often have to see many health professionals with high frequency. They need the most care, and they consume most of the health care dollars, so making care delivery efficient and easy for them to stay on top of treatment is a gigantic step in the right direction. Chronic patients with diabetes, asthma or a heart condition can do follow-ups with their physicians and get guidance on therapy and diet.
"[Telehealth] literally takes the health care system, packages it and delivers it as needed to the hands of employees [wherever they are] ... It's a much broader application than just creating a Web chat with a physician in a far away location," Schoenberg says.
Recently, there has been tremendous progress with large employers helping their employees focus on work by providing easy access to physicians for employees and dependents. The most straightforward way to do this for a geographically dispersed workforce is to implement a telehealth program in large companies with many campuses.
Many benefit integrators and brokers are acquiring these systems for all employers they handle, bringing these services to small- and midsized employer clients.
Telehealth takes hold
"There's been a lot of advancement from a technology perspective over the last couple years ... both the quality [increase] and the cost being driven down has made this a more feasible alternative," explains Peter Hotz, Walgreens group vice president.
"Patient engagement can drive long-term lifestyle and behavior changes, and really drive improvements in health status ... We worked with Cisco to determine how we can use technology to expand the reach of an worksite health center into the reach of a smaller population," Hotz adds. "As the technology improves and becomes more affordable, and people become more accepting of electronic means of interface, it takes the elements of face-to-face engagement, but does it in a way that allows us to reach a much broader population."
Walgreens started a pharmacy in Cisco's main San Jose, Calif., site two years ago and took over remote care for remote sites about four months ago. The company has a full primary medical center model in the main campus, and its North Carolina satellite office has a nurse to do hands-on help as well as facilitate contact with a physician in California.
The LifeConnections Health Center in San Jose serves approximately 12,600 individual patients, or 47% of Cisco's employee population and 20% of its San Jose dependent population, through approximately 23,000 visits annually. The LifeConnections Clinic in North Carolina serves approximately 480 individual patients, or about 10% of the employee population.
Cisco has reduced costs in medical claims, saved in productivity and increased employee engagement in health coaching and condition management. Based on recent data, the patient-centered medical home in San Jose, where they use Cisco health technology solutions, may reduce medical claims costs by up to 14%.
Schoenberg estimates that a telehealth station costs one one-hundredth the cost of hiring a nurse for a year at an onsite clinic. The beauty of telehealth is that an employer is able to utilize the same medical staff from their headquarters' clinic in satellite offices.
In addition to accessibility in remote campuses, the system will allow employees access from their homes in case they have issues outside of work hours. These efficiencies allow employers to expand their clinic services because if they decide to add a physician to the onsite clinic, for example, a telehealth program means they don't need to add an additional physician at every campus; one can serve them all. Other examples to expanding health care offerings include adding a physician, a nutritionist, or a health specialist for employees who suffer from severe stress or sleeping disorders.
OptumHealth launched its NowClinic in 2010 with Delta Airlines. "We wanted to develop a solution that was giving people fast and convenient access to doctors wherever and whenever they need care," explains Karen Silgen, OptumHealth's senior director of product development.
By collaborating with American Well, the NowClinic has spread to clients and all consumers in the 18 states in which NowClinic is live (as of presstime) and is available to 150 million Americans in these states. Further, OptumHealth has launched with over 35 different employers across the United States.
Delta Airlines has onsite clinics with computers in satellite offices, and any computer connected to the Internet can use NowClinic for those traveling or teleworking, or during off-hours.
In the first phase of implementing the NowClinic Telehealth initiative, Delta Airlines communicated with mailers and emails to employees in different locations that it would soon be rolled out to build awareness. In the second phase, the airline brought people onsite for health fairs and sign-up events to generate enthusiasm. In the third phase, word of mouth took over. People loved the convenience, low cost and efficiency of the program, and were quick to recommend it to their colleagues.
"The employees have been enthusiastic about the NowClinic program and concept because they immediately get it. It's increasing access to care without taking away the care they have today at the same cost they always have, but now they have much easier ways to access a physician, particularly in evenings, weekends and when they're away from their normal setting," explains Lynn Zonakis, managing director of health and strategy resources at Delta Airlines.
"We're noticing that employees are using NowClinic online care as opposed to going to an urgent care center for minor ailments [for which] they may not need an in-person exam," Silgen says. "It's a big time-saver for productivity and helps support the employer as well as the employee."
Cost varies
Cost and implementation details vary by organization. Employers should consider whether they want to set up the program themselves or subscribe to services their health plan provides. Large employers often run their own telehealth program to cater to their employee base.
They also must determine which services they want to deliver. Which medical professionals will work with the community - nurses, physicians and/or specialists? Will it be available 24/7 or just certain days? In general, the cost is not about infrastructure, it centers on paying for physicians.
"I see this being an important part of many employers' benefit plan design. As they start to think about how to increase the total population health, this is one component of it," Silgen says.
Right now, employees can connect with a physician or nurse; soon it will expand to wellness coaches, for example.
"In the long run, about 10 years [from now], this truly is going to revolutionize how people are able to connect with care providers," says Silgen.
