In the last four years, a new and highly effective service, Telemedicine, has evolved that can reduce medical claim costs by $70 per month per employee. Unlike wellness programs, where employers attempt to change the employees’ and their dependents’ lifestyle, the Telemedicine results start immediately and is quite simple.

History of broker efforts to reduce claim costs

For years, new ideas have been put forth to stabilize the cost of medical care claims. These include:

• Deductibles
• Co-insurance
• Second opinions
• Pre-admission certification
• Dollar and frequency limits on some services
• PPO & HMO networks
• Co-pays
• Health Risk Appraisals
• Smoker/non-smoker rates
• Wellness programs
• Onsite pharmacies and clinics

Telemedicine is changing the way people seek and get medical advice, diagnoses, and prescriptions. Prior to 1950, most care was provided with a home visit by the doctor, or phone conversations with the doctor. Gradually, all of this changed. Patients had to go to the doctor’s office or emergency room. Patients could call in but the doctor stopped taking or returning calls. Now voicemail messages are left and a patient waits for a return call from the nurse. This is usually followed up with a request to come in to see the doctor later in the week or the next week. A conversation with a doctor is a rarity.

Or, as I recently experienced, my granddaughter received a dog bite and the nurse said, “We are too busy, go to the ER room.” A $1,400 claim resulted for an exam, bandaging, and medication.

How many of us have had the doctor call back or have been told that to get a prescription refill, you needed to come to the office first? Doctors do not earn money from making phone calls or prescription refills!

Telemedicine provides access to board-certified doctors every hour of everyday – 168 hours/week. Doctor’s offices are potentially accessible only 35 hours/week.

The Telemedicine doctor has access to the medical history and medications of every family member which was provided over the phone, fax, or internet when the family enrolled. The doctor does the following over the phone or two-way video conference:

• Listens and asks questions.
• Can provide a diagnosis, treatment recommendations, give advice, or refer the patient to a specialist, urgent care center, or even the ER.
• When appropriate, the doctor calls in a prescription to the patient’s pharmacy or one that is open 24 hours.
• Sends a copy of the discussion to the person’s primary care physician.

The caller is charged $10 for the phone conference, which generally lasts 10-12 minutes.

All of this happens 24 hours a day, every day of the year. No waiting, no worrying, no travel, no lost time from work or school. No sitting in the waiting room with other sick people who were waiting when you arrived.

The American Medial Association states that 70% of office-visits can be handled over the phone and that over 50% of ER visits are not emergencies but a place where people can go to get care when they either do not have a primary care doctor, or could not see their doctor (weekend, middle of the night, or while traveling). These savings in claim costs will range from $300/year for a single employee or over $1000/year for a family of four. These savings reduce office co-pays and claim costs to the employer’s plan.

In the near future, kiosks will be in schools, hotels, factories, offices, and malls for people to get instant advice and care. With two-way video possibilities already being used, and blood pressure and heart monitoring done remotely, telemedicine will become much more than a phone discussion. The future has arrived and will replace the old methods now in place.

Have you swtiched to this model? Will you? Share your experiences in the comments.

Schultz, CLU is a principal in Simple LLC, a company that creates unique products for benefit brokers and their clients. He has 45 years of experience in employee benefits including his prior brokerage firm of 30 employees. He can be reached at roger.schultz@simple.us or 404-401-3040.