Telemedicine (Finally) Arrives as ‘Front Door’ to Care

Sixty-nine percent of firms with 50 or more workers offer health benefits that cover healthcare services provided through telemedicine in their largest health plan. But according to Willis Towers Watson’s 2018 Healthcare Changes Ahead survey, only 2% of Americans have actually had a telemedicine consult. What’s been the biggest barrier to more widespread adoption?

When it comes to adoption, consistently we see the same three core barriers to usage across different populations. First, there’s lack of awareness: “I didn’t know this service existed or that I was eligible for it.” Then, there’s lack of awareness in the moment of need: “I didn’t remember I had it.” And finally, there’s a question of confidence that he or she will feel better if they use this option: “Will this solve my problem?”

On the flip side, we see clients with the highest utilization having similar things in common. First, communicating and educating employees on the availability and value of virtual care is critical. We spend a lot of time and resources on outreach to groups and members to drive awareness. Second, employers and brokers that partner with us and advocate with members to use our services see much higher utilization. Third is plan design. This can have a significant impact, which is why the vast majority of our broker business is written with no co-pay, so the service is free to employees. And access and technology are important. The experience needs to be easy and intuitive for the member, which is why an engaging app and web experience is so important.

When we combine all of these factors along with additional clinical services like mental health, dermatology and expert second opinions, it is very common to see utilization above 50% through our broker channel of business.

With a 50% increase in volume of patient visits, how do you think this global pandemic will change the national perception of telemedicine post coronavirus?

The role of virtual care has absolutely changed forever in the healthcare system. As working from home and in-home self-quarantine have become the new reality for millions of people and they look to get medical care and advice from the safety and convenience of their own homes, we’ve seen visit volumes, questions and registration requests accelerate really quickly.

Virtual care has been introduced to a whole new population. Over 60% of those who are using our services had never used virtual care before the COVID-19 outbreak.

Post COVID-19, I think virtual care will no longer be seen as a separate and isolated way to access healthcare but instead will act as the “front door” to the healthcare system that provides members with the best experience and outcomes across clinical services.

What do you think will change about the nature of virtual patient visits moving forward?

For many conditions, virtual care actually proves to be more effective than in-person visits as a result of better care coordination and fewer barriers to access, such as distance, mobility and time constraints. In this time of social distancing—where many people are cautious of going to the doctor’s office—I think we’ll continue to see an uptick in visits for a wider array of conditions, moving beyond the everyday needs to addressing mental health, chronic and complex care, from nutrition and dermatology to exercise-based treatments and second opinions.

We’ve also transitioned and activated thousands of physicians onto our platform, which means more physicians are now trained to deliver clinical care and patient experiences virtually.

Have your care coordination efforts between providers, insurers and other stakeholders changed since virtual visits have ramped up?

To manage the influx of demand, our clinical operations team has developed staffing models that factor trends by month, day and time of day, as well as geographic considerations. Using that information, we are working closely with the CDC to monitor the outbreak and layering in what we know about plan sponsors’ communications and member co-pay adjustments to forecast the future demand for virtual care services.

To support our doctors, we have activated a Coronavirus Response Team trained on the latest protocols for local and national notification, testing and management of suspected cases. The team has deep experience in public health preparedness and is led by professionals who implemented responses for Ebola and other public health crises globally.

We have also altered our care delivery platform to specifically address COVID-19 symptoms and help our doctors triage and track suspected cases, then engage the Coronavirus Response Team for coordination with the local public health organization when it’s appropriate.

What are the most pressing questions you’re receiving from health insurance brokers?

In the beginning, we received a lot of questions from brokers and other clients focused on education. They wanted to understand what resources were available on the facts about COVID-19 and the best way to get care.

In response, we made a variety of resources available, including a COVID-19 self-assessment questionnaire to help members evaluate personal risk of contracting the virus and related complications before requesting a virtual care visit. We also shared a test site finder that offers state-by-state and site-by-site specific information on testing criteria at more than 1500 verified sites.

Now, we’re fielding a lot of inbound requests to expand services for more members and our clients. Mental health services, for example, are a critical area of focus: we recently published results of a study showed that nearly half (47%) of U.S. respondents report that their mental health has been negatively impacted by the COVID-19 pandemic. Our clients want to help people access the mental healthcare services they need during this challenging time, and we’re here to help.

Most recently, our broker partners want to understand the impact of regulatory changes such as the CARES Act. It’s a welcome change for employers, particularly as they look to provide quick access to virtual care options. One item that came out of the CARES Act is that it clearly outlines that HDHPs with an HSA can cover virtual care expenses even if the participant hasn’t reached his or her deductible.

What are the lessons learned so far?

While the COVID-19 outbreak continues to unfold, a few things stand out to me at this point. Virtual care helps people access a diverse spectrum of care. While the focus and immediate needs center on episodic, general medical care, it’s clearer than ever that virtual care has a role to play to support the whole person—mind and body—from mental health issues elevated due to isolation and social distancing to helping people navigate more complex issues when traditional treatments are no longer available.

The chronic conditions that people were facing before COVID-19 remain, even as their treatments may have been delayed. This pause creates an opportunity for people to get second opinions to validate their diagnoses and treatment plans and to explore other treatment options.

Another takeaway so far is that scale matters. In Q1, we delivered more than 2 million virtual care visits and have been conducting as many as 20,000 visits a day. It takes stable technology, availability of doctors, and ample customer service agents to deliver high-quality care at this scale.

Finally, I think our ability as an entire organization—every team from sales to clinical staff—to remain agile has been critical so that we can adapt to these changing market conditions and client needs.