Telemedicine plans expand to include specialists

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Telemedicine is a vital part of employer health plans as employees are embracing virtual doctor visits more than ever. Nearly 60% of employers with 500 or more employees provide telehealth services in their medical plans, and access to these services doubled between 2015 and 2016, according to a recent AHIP study. The most popular medium for telehealth is telephone (59%) followed by email (41%) and text messaging (29%)

AHIP reports that telehealth is delivered and accessed via three methods. Real-time video, or synchronous conversation, leads the way where the patient and medical practitioner interact via video with audio. The second method is “store-and-forward” for asynchronous conversations, where a patient sends a doctor or specialist a scan or image of a test result. The third method is “remote patient monitoring” that offers continuous tracking of healthcare data from a patient.

Via these methods, telehealth plans are offering access to medical specialists. Employee Benefit News spoke with Chris Regal, senior health research associate for AHIP, about the role specialists are playing in the telehealth landscape and why they thrive virtually like their fellow primary care doctors and nurse practitioners. What follows is an edited version of that conversation.

Employee Benefit News: When we think of telehealth, we usually think of virtual visits with nurses and primary care doctors. Are more specialists seeing patients via telehealth these days?

Chris Regal: Yes. One thing we see is primary care, or basically [medical professionals] trying to keep people out of ER settings or urgent care settings, but we are definitely seeing growth particularly in behavioral health. One plan our report highlighted offers multiple time allotments, whether it's 30, 45 or 60 minutes, for behavioral health access. Additionally, we've seen specialist access through dermatology. One of the favorite anecdotes was with regard to nutrition services. A nutritionist had a patient take their cellphone that they were facetiming the patient with, and walk them through their refrigerator to help plan meals.

Some benefit plan advisers are telling us they are helping with weight management and medication management as well. There are a variety of specialist services being accessed.

EBN: Are there certain disciplines of medicine or specialties that don't lend themselves to telehealth?

Regal: Some services do require hands-on visits. When someone uses a telehealth service and they think they need to go to an urgent care facility, they will make that recommendation.

EBN: How does seeing a specialist via telehealth work? Is this considered a second opinion where you have to go to a primary care doctor first who then says yes, you can go see a specialist?

Regal: From a plan perspective, in a lot of cases the plans contract with third-party specialists. Some of the more common ones are Teladoc, MDLive, Doctor on Demand, and through these services, the plan contracts with a large network of doctors and specialists. If your plan allows for this, they are providing access to a network of doctors who are licensed to practice in your state and that is covered under the plan.

EBN: Do regulations for overseeing telehealth vary state by state? Will we see a national policy when it comes to telehealth medical professionals?

Regal: Right now, it is state by state. There are pretty wide variances where one state will allow whether you need to see a doctor in person in order to have a follow up [and another will not.] Some states require very specific payment rules. There is a national policy that's pretty restrictive for Medicare and Medicare Advantage plans are a little more open but Medicare itself is pretty tight.

EBN: We're in the midst of an opioid crisis. How do you prevent people from gaming the system and shopping for doctors who will give them narcotics?

Regal: One of the major benefits we have heard is that information from the telehealth plan goes directly into [patient plan and medical records] so you wouldn't be able to have somebody see the six different doctors. This is all being recorded and that doctor or specialist will be able to access your records when you have a visit with them.

EBN: Who's pushing for this, the benefit advisers or employers?

Regal: Everyone is moving in the same direction. The employees, employers, benefit advisers and the plans themselves are seeing that this is the wave of the future. We've seen the innovation come from the provider side, the plan side and in some cases employers are asking for that. The plans are really helping to innovate with this adoption. The ultimate goal for all parties is to expand access and be as hospitable as possible to patients.

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