What the Pandemic Has Taught Us

pandemicWhether you’re a TPA, broker, employer, plan member or healthcare provider, the past year has been unlike any other. While adapting has often been difficult, some of the lessons learned can have a positive impact on employee healthcare in the future. Here are a few to consider as you begin your planning for the coming year.

Open Enrollment

According to the IFEBP, 1 in 5 companies handled open enrollment differently in 2020, with many using virtual benefit events. Virtual benefits meetings can be viewed by members from any location at any time. In addition, members can easily share their benefits information with a spouse or family member, something that cannot be done with traditional in-person events. Many used short video introductions and important details were typically made available on secure online employee portals following the virtual event. Offering a dedicated email address, phone line or online chat option can make it easy for members to ask questions.

Telemedicine

Think for a moment that Cleveland Clinic delivered 1.2 million virtual physician visits in 2020, compared to just 37,000 in 2019. Even after resuming in-person appointments, 30% to 40% of all visits at Stanford Health Care are virtual and while physicians and patients say there is certainly room for improvement, nearly 3 of 4 patients say they are likely to choose a video consult over in-person in the future. While many physicians say they would prefer to use telehealth visits to manage chronic diseases, many cite low or no reimbursement and technology challenges on the part of their patients as the biggest obstacles to its continued use.

Health Benefit Value

One challenge that remains even as the threat of Covid-19 lessens is the rising costs facing employer-sponsored health plans. Research from the Kaiser Family Foundation and The Hartford show a decline in the perceived value of health benefits by plan sponsors and members. These trends can only change as personal service improves and the barriers standing in the way of healthcare cost transparency are overcome.

As an independent TPA, we place the needs of your health plan and members first by providing personalized service and striving to eliminate costly conflicts of interest that have plagued our healthcare system.

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What to Expect from Virtual Health

sip-telehealthResearchers define virtual health as continuous, connected care delivered using digital and telecommunication technologies. Healthcare consumers can think of virtual health as telemedicine and video doctor visits, remote patient monitoring, asynchronous communication, medication adherence and provider-facing solutions such as virtual consults and second opinions.

To consider the future impact of virtual health, the Deloitte Center for Health Solutions surveyed clinicians and healthcare executives, with most agreeing that a fourth or more of all outpatient, preventive and long-term care will move to virtual delivery over the next 20 years. Physicians expect to be spending more time in face-to-face interactions with their patients as virtual assistants handle appointment scheduling, prescription orders and transfer of clinician notes into electronic medical records. Nearly 75 percent of respondents see improved clinical outcomes resulting from home-based monitoring and faster, easier access to health plan information helping members and providers alike. Finally, patients can expect virtual physician visits to save them valuable time compared to physical office visits.

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Should You Be Doing More About Mental Health?

woman at deskThere is little doubt that the COVID-19 pandemic has taken a toll on the mental well-being of many Americans. In addition to dealing with fear of the virus and social isolation, economic pressures have continued to grow. Many who have continued to work have been forced to balance working remotely with caring for children who would normally be in school.

A survey by telemedicine giant Teladoc recently showed that nearly half of American workers say their mental health has been negatively impacted. The more disturbing statistic is that only 27% say their employers are taking steps to provide help.

What Others are Doing

While larger employers have long made employee assistance programs available to those in need, the expansion of telemedicine has enabled employers of all sizes to provide access to behavioral health professionals. These appointments traditionally were held by phone, but many are now conducted by video using computers or smart phones.

As the pandemic has continued, onsite employers’ clinics have shown a significant increase in mental health and stress-related cases. Some health systems have placed mental health providers inside workplaces to provide quicker access to treatment. For more information or to strengthen your health plan in this critical area, contact your account representative today. systems have placed mental health providers inside workplaces to provide quicker access to treatment. For more information or to strengthen your health plan in this critical area, contact your account representative today.

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Getting Creative About Behavioral Health

behavioralhealthWith behavioral health conditions impacting one in five Americans, it’s no wonder we’re seeing more employers search for ways to provide members with better access to behavioral healthcare benefits.

Statistics show that many employees, including some that are insured, fail to get the mental healthcare they need. Because self-funded health plans provide plan design flexibility, some plans are taking bold steps to address this growing need. While many are using telemedicine to improve access and lower costs, some employers are treating out-of-network behavioral health treatment as in-network, enabling employees to pay the same amount for treatment regardless of which provider they use. Others are covering out-of-network behavioral healthcare services even when their plan doesn’t cover out-of-network services for other types of care.

When you consider that mental illness has become the greatest cause of disability claims in the U.S., it is not surprising that employers are looking for ways to help employees obtain the care they need.

Significant Action is Warranted

There is plenty of research to show that Americans are not getting the mental healthcare they need. According to Mental Health America, despite having health insurance, 56.5% of adults with mental illness received no treatment in the past year.

Another problem is that behavioral health treatments are rarely classified as primary care, and are regarded instead as specialty treatment. This makes people find an in-network provider, go out-of-network, pay higher out-of-pocket costs or avoid treatment altogether. Claims data from Collective Health shows that more than 40% of the 2017 behavioral health spend was out-of-network, which is many times the amount spent on primary or preventative care.

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Troubleshooting Telemedicine

sip-telehealthThe healthcare landscape is changing as providers increasingly offer virtual care options, and naturally it’s taken some getting used to. A recent study by the Deloitte Center for Health Solutions found that while patients who have used virtual care reported a 77% satisfaction rate, only 44% felt that their wait time was reduced compared to an in-person office visit. Some offices are designating doctors for virtual care on specific days of the week to circumvent wait times caused by healthcare professionals bouncing between in-person and virtual patients.

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States Moving Forward on Telemental Health

States are moving toward telemedicine to help students access mental health services. Minnesota and Utah have proposed telemental services in order to reach students with underserved mental health needs. Students with unmet mental health needs experience many obstacles, with conditions such as depression and anxiety negatively impacting their attendance and performance.

Telemental health is being utilized to reach those in areas without child therapists or in other “healthcare deserts”. Texas has successfully implemented telemental health programs since 2012, connecting thousands of students with much needed care and treatment. One proposed Minnesota bill suggests launching four telemedicine projects aimed at improving access to telemental health services for students. Proposed grants would help provide dedicated space in schools and the technology needed for students to access telemental health services. A bill in Utah would enable the Division of Substance Abuse and Mental Health to create a two-year program using a telemedicine platform to facilitate remote consults between children and child psychiatrists.

Legislators and school officials in a number of states see many benefits to pursuing a telemental health platform, including the potential to identify young people contemplating suicidal or homicidal actions.

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Getting People to Use Telemedicine

mobile-device24/7 physician access by phone or video has the potential to do great things for health plans and consumers. Getting a doctor’s help without waiting in a medical office is a great convenience, especially if you’re traveling or your primary care physician is unavailable. The challenge, however, is that telemedicine does not sell itself – it needs to be communicated over and over again if we want members to remember they have this great, easy-to-use benefit instead of driving to an urgent care center. Technology is great, but it won’t activate itself. People are creatures of habit and it takes a good deal of effort to change behavior. Low tech tactics like email reminders, flyers or refrigerator magnets may just be what the doctor ordered when trying to drive home the benefits of telemedicine.

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Robotic Coronary Intervention

healthResponding to an anticipated shortage of cardiologists and other specialists, Mayo Clinic is using a $3.3 million charitable grant to conduct a preclinical study enabling doctors working at a remote location to use telemedicine to place heart stents by guiding a robotic arm. The study, being done in collaboration with a robotic equipment manufacturer, is being referred to as “telestenting” because it takes telemedicine to a new level.

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Empowering Employees: Big Talk, Little Action

telemedicineTelemedicine offers a lot of potential for everyone – added convenience for busy families and lower costs than a traditional office visit. But as helpful as this service can be, it will only make a difference if it is used.

Low utilization is not unique to telemedicine. It’s a common problem with many new, well designed and well-intended health care services. Encouraging plan members to actually use new offerings is a challenge for employer groups, large and small. And while utilization is often higher in self-funded health plans, all employers need help turning talk into action. Here are a few ideas to consider:

It’s all about them – With health care consuming more of everyone’s income and attention, we all have a vested interest in our benefits. And while wonderful tools like telemedicine keep coming to the table, you need to look at these offerings from your member’s perspective rather than your own. Talk with your employees; ask if a service will help them and listen to their feedback. If it can add real value to your employee’s lives, utilization will follow.

Talk about health, not cost – Research indicates that when it comes to their health and wellbeing, there are many things members would prefer to hear about than fees and costs. A majority are interested in improving their health. It takes time, but focusing on current health risks and personalizing communications as much as possible will help members want to get more engaged.

Educate to empower – Transparency tools and online portals are no different than other modern advances. If people don’t understand them, they will never catch on. Like telemedicine, unless employees understand how to use it and when they can use it, they will never realize the benefit of having an experienced, board certified physician, with access to their medical records, available to help them 24/7.

While it seems that other new disruptive innovations, such as Alexa, catch fire overnight, they do take time. Since your employee communication budget likely pales in comparison to those driving consumers to Amazon, talk with your TPA about new ways to zero in on the needs of your employees. Doing so can lead to increased utilization and a happier, healthier workforce in 2018 and beyond.

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TeleMedicine Continues to Grow

telemedicineIf you haven’t interacted with a doctor by smart phone, email or webcam recently, you’ll be interested to know that the American Telemedicine Association reports that more than 15 million Americans received some kind of medical care remotely last year.

For those employed by a large company or living in a major metro area, it is common to view telemedicine as a virtual doctor visit or a substitute for an in-person office visit. The fact is that electronic communications are impacting the delivery of healthcare in many ways.

  • Some doctors are consulting with one another to make critical decisions on heart attack and stroke victims
  • Patients are using smart phones to relay blood pressure, heart rate and other vital signs to their doctors in order to better manage chronic conditions
  • Virtual Care Centers are providing remote support to ICUs and ERs in small, rural hospitals where a physician may not be on site 24/7

Many question whether the quality of care is keeping pace with the rapid expansion of telemedicine, and state rules governing telemedicine are constantly evolving. At the same time, health plans and a growing number of members view the services as a convenient way to get medical care without leaving home or work.

The AMA recently approved new ethical guidelines for telemedicine, calling for participating doctors to recognize its limitations and ensure that sufficient information is available before making a clinical recommendation. With existing telemedicine providers expanding and major teaching institutions gearing up, there appears to be no slowdown in sight.

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