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Telemedicine: Great Intention But How Does Such a Great Idea Underperform?

Outline: On the surface, Telemedicine appears to be an effective tool at increasing access and lowering cost. The problem is it seldom does either..

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The following is told from the perspective of Randy Baker, CEO MedCall Advisors:

It is undeniable that Telemedicine is a great intention.

It is not a new concept but rather a practice that has been around for a very long time, yet still suffers from shocking under-utilization. I was born in 1959 when Dr. E. C. Neeland, a family physician, gave me a gentle pop and introduced me to the world. Over the next 10 to 15 years, Dr. Neeland would attend to each medical event I encountered including the measles, flu, a broken arm, pink eye and more. Often my mom would call Dr. Neeland who dutifully took the call to listen, calm my mom and offer his sage medical advice, and to determine if an office visit was appropriate. He would routinely call the drugstore next to his office to authorize a prescription if needed.

I guess this early experience tuned my ear to catch Dr. Ben Carson discussing the complexity of medicine today and proclaiming the only thing required for effective medicine is a doctor and a patient. I was actively engaged in the great debate of the Affordable Care Act. Most government policies may be well intended, but the creators and enablers lack the capacity to contemplate the unintended consequences of their actions. Just a few of the unintended consequences are increased pressure on emergency departments, dissatisfied and frustrated providers, decreased capacity, longer wait times for care and the slow degradation of quality of care.

Telemedicine should be an effective cost containment strategy for individuals, employers and carriers. It also deserves a starring role in Value Based Care and Accountable Care models. When done correctly, Telemedicine will deliver quantifiable economic triage.

On the surface, Telemedicine appears to be an effective tool at increasing access and lowering cost.

The problem is it seldom does either. With utilization rates mired in single digits, it simply is not working. If you are paying just $1.50 per month for 1,000 employees and $49 per encounter with a 3 percent utilization rate, the cost of each Telemedicine visit is $649. At a 10 percent utilization rate, the cost is still $229 per visit. So the solution is to increase utilization, right? But how?

The only way to drive utilization is to facilitate better outcomes and patient satisfaction. Therein lies the challenge with traditional Telemedicine business models. In a world of instant gratification, callbacks, appointments and the limited list of acceptable conditions for which you can call does not remove barriers to care and induces patient frustration. When a patient calls seeking medical advice only to be told their condition is either not on the list or that the symptoms need to persist for 7 days or more, it is simply frustrating and we've likely lost another Telemedicine client. To further exacerbate the problem, Telemedicine companies blindly hire thousands of physicians or outsource overseas physicians who accept random assignment of calls resulting in a lack of continuity of care. Follow-up is virtually non-existent creating a risk to care quality.

At MedCall Advisors, we believe the only way to drive utilization and increase access is to first remove all barriers to quality medical care. We facilitate immediate connection to physicians in real time when medical events occur. Second, we facilitate access to physicians that are prepared to accept and triage all calls including emergency and non-emergency events. Notwithstanding the obvious clinical limitations of providing Tele-Triage, qualified physicians can impact nearly all medical events by executing intellectual medical decisions in lieu of emotional decisions made under stress by non-medical folks. Our strategy uses only ED physicians specifically trained in Tele-Emergent Care. ED physicians are versed in multiple clinical disciplines and can assure patients get the right care at the right time from the right provider and in the right venue. Real time intervention by a qualified Physician into medical events can substantially reduce costly, avoidable ED and urgent care visits. Qualified physicians can make the best medical determination for the most appropriate level of care. Moreover, we use only staff physicians allowing easy access for consistent follow-up calls.

Telemedicine can be an effective tool when telegraphed as a targeted strategy.

Regardless of whether it's used for healthcare or workers' compensation medical cost reduction you must first understand the pain. Business experiences and cost issues are not one size fits all. Therefore, any telemedicine strategy presented with a price sheet will remain largely ineffective, and a standard price sheet is basically a bet against the business. Once we understand how a group accesses and utilizes care as well as how much it cost, then can we customize a fully transparent strategy to attack the cost with mutually aligned interest.

To gather this understanding, we underwrite claims data and loss runs to customize a strategy that mutually aligns incentives between the provider and the employer. We set economic goals that ensure a negative cost and benchmark the progress monthly through utilization and savings reporting.

As Telemedicine providers, it is imperative we all be as committed to the clinical practice and the economic triage to our clients as we are to our own business models. If we combine this commitment with real time intervention, patient satisfaction and a transparent, well-documented reporting system will increase utilization. Increased utilization along with better outcomes will excite patients, employers and ultimately allow Telemedicine to finally achieve its potential.

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