Confession: I fired my primary care provider a few years ago. She was really nice and seemed to be a great doctor. In fact, she had been named to multiple lists of the best doctors in the city. But I never got out of her office without spending 45 minutes or more in the waiting room, another 15 minutes waiting in an examination room, and then an average of 3-5 minutes spent with her. It didn’t seem right, so I got recommendations and switched doctors — to someone with “only” 30-minute wait times and 10 minutes of face-time.
Then, I gave telemedicine a try. I really liked it. I think you would, too.
As you review your benefits options for the coming year — or the benefits that you have just selected — you may have noticed that telemedicine is part of your health plan or that your employer has provided you with a telemedicine account in addition to your health plan.
Telemedicine is a great way to get physical and mental health help from the comfort of your own home at a generally lower cost than a typical doctor office visit. If you don’t know about telemedicine or you do but still have reservations, keep reading and know that its key benefits are the same three you would look for in virtually any service: cost, quality, convenience.
“Patients do not immediately understand the value, accuracy and quality of video visits,” says Dr. Ian Tong, Chief Medical Officer at Doctor On Demand, which launched its telemedicine app in 2013. “[They] assume there is no examination. That could not be farther from the truth. Every patient must be assessed with an exam, which is why video is critical to the performance of quality visits.”
Doctors are nothing if not data-driven. They are trained to make diagnoses by a fairly quick process of elimination. A broad swath of what ails us can be revealed to doctors in relatively few questions. And it can be done without having to leave your house, which takes on added value when you or your children are sick and don’t want to go anywhere or infect anyone else.
“Care is returning to the home and patients love the experience,” says Dr. Tong, noting that telemedicine does consistently well in patient satisfaction surveys.
Be that as it may, it can still be a challenge to get people to that first telemedicine experience. I had a telemedicine account for more than a year before I used it for the first time, because I implicitly thought it wouldn’t be as good as my doctor. I was wrong. In a matter of minutes, I had a diagnoses and a treatment plan that wiped out my ailment and the only time I had to leave the house was to pick up my medicine.
We’ve been conditioned to believe that we need to be in the same room as our healthcare provider, so that they can look us in the eyes, poke us and prod us and tell us what’s wrong. Dr. Tong says that not only do you not need to be sitting across from your patient to provide good care, but that telemedicine has uncovered a multitude of ways to provide care for all manner of needs, physical and mental.
“I think the best conditions [to treat via telemedicine] are those where patients with chronic illness can get both medical and behavioral treatments that empower them to manage their conditions better,” he says Dr. Tong. “Conditions like diabetes, hypertension, high cholesterol, obesity, depression, anxiety and tobacco use are killing Americans. It’s time we made care more accessible for these patients and stopped forcing them to sit in waiting rooms.”
While virtually all medicine could potentially be telemedicine, you may not want to shift all the way over. A good way to think of the relationship between physical and virtual care that suits your comfort level is to use your primary care physician for preventive care and telemedicine for immediate care.
All of this is to say that telemedicine is a great idea for your health and for your pocketbook. The way most telemedicine programs work is that you pay a monthly fee for the service and then either have unlimited consultations or a set number of consultations (video chats) per month. However, the more common approach is that your employer will negotiate “office visit” and other rates (therapy, psychiatry) and you will pay whatever that negotiated rate ends up being. Spoiler alert: It’s virtually always less than what you would pay your own doctor for an office visit because 1) telemedicine can run cheaper because they are not maintaining physical office spaces, and 2) your employer will most likely help to subsidize the cost of visits because it helps them keep their own healthcare costs down.
One warning, however: Telemedicine can be so convenient compared to the old way that you may end up becoming a much higher user of services, which ultimately drives up overall healthcare costs as well as your own personal costs. A good rule of thumb is that if you wouldn’t consider going to the doctor under normal circumstances, you probably don’t need to dial up a tele-doctor.
With that said, if you are a salaried employee who is comfortably middle class, I’m likely preaching to the choir. You just need to get over the “virtual” hurdle and you’ll adopt telemedicine for most of your care and never look back.
The real challenge is ensuring that the lower-wage workers at our companies and others both have access to telemedicine and that they know how to use it.
A chief medical officer for an enrollment technology solution to whom I spoke noted that telemedicine is typically more available to higher-wage workers at companies with largely professional workforces than low-wage workers at companies with mostly hourly workers, and therefore the marketing and education that accompanies these offerings tends to target the needs and means of the higher-wage workers. Such a focus doesn’t have “as meaningful an impact on reducing emergency department use among low-wage workers,” which ultimately doesn’t drive down costs or change behavior, he said.
“The key point is that we have a renewed appreciation for the need to target specific subpopulations if we’re intending to have meaningful impact on healthcare costs and patient outcomes,” he continued.
You hear that, employers? In order to get the most out of these offerings on behalf of your employees — and the company’s overall healthcare expenses — be sure you’re making things like telemedicine broadly available to workers and that you’re communicating to all of your demographic groups on how to make the most of telemedicine and all other benefits. That means ensuring lower-wage workers have the tools to make the most of telemedicine for their health and financial well-being and so that higher-wage workers have the tools to understand when they may have too much of a good thing.
Also, employers, keep in mind that communication doesn’t always just mean writing emails and hanging posters. Money talks.
One approach to try is to incentivize employees to use telemedicine. For example, by offering employees on high-deductible health plans an HSA contribution for their telemedicine visits, you may divert them from visiting an emergency room or instacare clinic, which could easily cost them 10-50 times as much as that quick video chat and also cost their employer a great deal more.
A similar rationale applies with geography. Those in rural areas who may not have easy access to primary care may go without treatment for too long, which may mean they’ll end up in the ER for something that was preventable. With telemedicine, they can avoid both prolonged unhealthiness and unnecessary expenses.
Reaching these diverse constituencies turns out to be good for the doctors who practice telemedicine as well.
“I feel I have become a better doctor as I learn about the cultural differences between different regions of the country,” says Dr. Tong. “Understanding why and how patient behaviors differ forces me to develop specific treatment plans.”
Dr. Tong asserts that telemedicine is one of the greatest innovations in patient-centered healthcare in decades. You can forgive his excitement for his own line of work, because he makes a great point. Sometimes it’s not a full paradigm shift that ends up changing the industry but rather taking what’s best about something and cutting out the inconveniences.
Telemedicine is still a relatively new thing and there are questions that should be answered that aren’t in this article — to name just three important ones: how to protect against abuses of the system, especially in relation to prescription drugs; how do we continue to break through bureaucratic barriers — telemedicine just recently became available in all 50 states; and finally and most importantly, how do you ensure that the care you’re receiving via video is being provided by licensed professionals? In the case of Doctor on Demand and other longer-term, serious companies in the business, a very rigorous vetting and assurance of board certifications, among other things, are central to their standards and practices.
Alternatively, you may have a phenomenal and always available primary care provider and have and have no need for telemedicine. If that’s the case, then congratulations, you are among the few. For the majority, it is delivering on the big three — cost, quality and convenience —in ways that are worth adopting in your own life that may ultimately drive us to a new way of experiencing a doctor’s care.