Ron Hurtibise Sun Sentinel published, July 1st 2019 7:33 PM EDT:

Is forced telemedicine the future of healthcare?

Would you take unlimited 24/7 access to primary care doctors via smartphone, tablet or computer, with zero out-of-pocket co-pays, if it meant you’d have to pay a lot more money to see your regular doctor in person?

Welcome to the future of telemedicine, also known as telehealth.

Insurance giant Humana is betting many will be happy with such a trade. The company has partnered with a telemedicine provider called Doctor on Demand to offer a discount-priced teledoc-based health insurance plan it calls On Hand.

The plan, which costs employers up to 20 percent less than traditional plans, became available in Florida on June 1.

A new telemedicine law signed last month by Florida Gov. Ron DeSantis will make it easier for physicians licensed out of state to provide services to Florida residents. Out-of-state doctors can pay a one-time $150 registration fee to see Florida patients.

Modern technology and ultrafast connectivity is undoubtedly changing how health care is delivered around the world. The internet makes it possible for specialists on the other side of the globe to participate in complex, delicate surgeries, as well as for surgeons to examine patients being treated by paramedics in an ambulance or on a living room floor.

Yet, online examinations have been widely available for several years now, but analysts say we’re just not warming up to the idea as they expected.

Humans, it seems, prefer face-to-face visits with their physicians.

That’s why Humana’s new plan raises the ante. By making visits free to the patient and throwing in most common lab work and prescriptions for $5 while making in-person doctor visits comparatively pricey for consumers, Humana, and other insurers, is hoping to compel sick people to consult teledocs.

What conditions are best suited for telehealth treatment?

Services vary, but most companies tout their ability to easily treat colds and flus, allergies, skin infections, asthma, upper respiratory infections, stomach viruses, fevers, sinus infections, headaches, irritable bowel syndrome and joint pain.

Long-term chronic ailments are also conducive to long-distance monitoring and prescribing, including conditions such as diabetes, thyroid problems, high cholesterol and high blood pressure, and weight management.

Psychiatric and behavioral issues are especially suited to telemedicine because they rarely involve invasive therapies. Most of the major telemedicine providers offer treatment options for issues such as addictions, depression, PTSD, eating disorders, insomnia, anxiety and postpartum depression.

Some patients might feel more comfortable seeking treatment by telemedicine for issues they might be embarrassed to discuss in person, such as erectile dysfunction or hair loss. That’s one reason specialized services have popped up for these issues.

What’s not treatable via telemedicine?

Doctor on Demand lists the following conditions they don’t treat: Traumatic brain and spinal cord injuries, chest pain and/or numbness, vomiting or coughing blood, lacerations, loss of consciousness, broken bones, severe burns or pediatric ear infections. And sorry, forget about opioids, except under limited circumstances, and medical marijuana.

How can I be treated at home when I don’t have any medical gear?

Members of Humana’s new plan get a welcome kit with a digital thermometer and blood pressure cuff. Services that plug into smartphones and transmit data back to health providers, such as glucose monitors and sleep trackers, are becoming more widely available.

Why are insurers and health providers pushing telehealth?

One reason is the belief that telehealth will lower costs for insurers and consumers.

Insurers believe costs for telehealth visits should be lower than in-office visits. In Florida, physicians wanted the law to require insurers pay the same amount for either type as they must in 36 other states. The state’s new law leaves it to doctors and insurers to negotiate reimbursement rates.

That’ll keep telehealth from growing at the “explosive” rate it has in other states because it reduces incentives for physicians to invest in the necessary technology and training, says Thomas (T.J.) Ferrante, a Tampa, Fla.-based attorney for the law firm Foley & Lardner LLP, who specializes in helping telehealth businesses comply with state and federal laws.

Will it be faster to see a doctor?

Telehealth will improve patient access to physicians, advocates say. The U.S. is facing a severe shortfall in the number of physicians available to an increasingly large population of baby boomer seniors. By 2030, the nation will need 121,300 more physicians than it will have, according to the Association of American Medical Colleges.

This shortage will most hurt people living in rural areas. Rural patients wait the longest for visits with specialists, such as neurologists, and find themselves driving farthest when they can’t afford to wait.

Absent reforms, the shortage will increase waiting times to see primary care doctors beyond today’s historically long spans. In 2017, patients in the Miami metro area waited an average 28 days after scheduling an appointment to see a primary care doctor, compared with 12 days in 2014 and seven days in 2009, according to a study by Merritt Hawkins, a national physician recruitment firm.

I’ve been hearing about telehealth for several years now. Have consumers warmed up to them?

Companies that launched telehealth services a few years ago aren’t exactly beating their chests about the results.

Cleveland Clinic was the first hospital in Florida to offer telehealth services to anyone willing to pay $49 for a 10-minute consultation (it’s $55 now). Nearly 3,000 Cleveland Clinic Florida patients have used its Express Care Online service since it was launched in September 2015. That’s 45 months ago, for an average of 67 online visits a month, or about two a day.

A UnitedHealthCare spokeswoman said the company didn’t have the number of Florida customers who have used its Virtual Visits app since it was introduced in 2016. However, she said visits have doubled each year.

Florida Blue also did not cite actual usage numbers for its TelaDoc service but said the number of visits have tripled since the service became available to patients in 2017.

Similarly, Baptist Health declined to say how many of its 35,000 enrolled consumers are actually using the app, while Sunrise-based telemedicine provider MDLive also declined to provide data, saying only that it expects about 1 million visits this year out of about 32 million consumers nationwide who have access to the service through their insurance plans.

Just seven in 1,000 people nationwide used telemedicine in 2017, according to an analysis of insurance claims data from OptumLabs Data Warehouse cited in a December 2018 Washington Post story.

A 2017 survey of 403 consumers by telehealth provider Avizia found higher usage rates — 18 percent said they use the technology. Among the 82 percent who don’t use it, 46 percent said they were less comfortable with the idea of a video visit than an in-person visit with a physician, while only one in five knew for certain whether their insurance plans covered telehealth.

So the idea is that once I try it, I’m going to like it?

That’s what proponents say. We’ll see.

UnitedHealthCare said more than 90 percent of users rated their visits five out of five stars.

Lyle Berkowitz, MDLive’s chief medical officer and executive vice president for product strategy, says 43 percent of the company’s expected million visits this year will be repeat users.

“Once they use us once, they are going to continue to use us on a repeat basis,” Berkowitz said in an interview.

Consumers give the service a net satisfaction score of 80 out of a possible 100, Berkowitz said, because they like the convenience of connecting with a physician in 10 minutes or less for consultations that generally last no more than 10 minutes.

“It’s convenient, easy, and as wonderful to use as Netflix is compared to going to Blockbuster,” he said.

It won’t be long before we have no choice, right?

Telemedicine is still an optional service for most people on employer-funded plans, and an affordable option (along with urgent care centers) for the uninsured. An MDLive visit costs $75 to any consumer, and rates are similar from competitors such as TeleDoc and Doctor on Demand.

If insurers want to increase use in the future, they’ll increase the number of plans that offer it as the most financially palatable choice.

Ferrante doesn’t think we’ll be required to use telemedicine services any time soon, but he sees health plans and providers increasing incentives to move patients along.

“It’s not a question of if, but of when,” he said. Physicians who are reluctant will eventually buy in, he said. “It will be driven by market demand. Some will do it earlier than others. Some will be really successful and others, not so much. Some will refuse to change and retire or be driven out of business.”

Can I see the same doctor?

You can claim one of the teledocs as “your” doc, but that doc likely won’t be located in your area, and perhaps not even your state.

But you can build a relationship over time by making appointments to see that same teledoc, Humana says.

It will cost more money than you are currently paying for an in-person visit to your local primary care doctor. In fact, unless you are getting a covered “preventative care” service, such as diabetes screening or a Hepatitis B screening, you’ll have to pay the rate your insurer negotiated for the visit – not a co-pay – until you’ve met your out-of-pocket limi.

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