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Paul Cerrato
Paul Cerrato
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Barriers To Telemedicine Slowly Crumble

A few courageous providers and insurers are seeing the value of treating patients in cyberspace. We need more risk takers.

Health insurance companies are known for saving themselves money by denying claims and burdening patients with high deductibles, but a few are starting to reposition themselves as capable of saving money and simplifying care for patients. At this year’s Connected Health Symposium in Boston, one insurer stood out for embracing an important tactic toward that end: a willingness to pay for telemedicine services.

At the Connected Health meeting, John Jesser, VP of Provider Engagement Services for WellPoint, explained that his company is partnering with American Well Systems, a telemedicine services vendor, to set up the program for its members. Before the program was set up, patients who needed to see a physician during off-hours had limited options: Visit the ER and spend about $600; see a physician in an urgent care center for about $150; or wait until the doctor is back in the office.

WellPoint introduced a new choice for its members, which only costs about $49. “Open up your laptop with a webcam, or pull out your mobile device or tablet. And in less than 10 minutes you’re face to face with a board certified primary care doctor… in a HIPAA compliant setting, paying with a credit card,” explained Jesser. If the member already has a medical history, the doc at the other end of the line also has access to all that data.

WellPoint joins a growing number of insurers that are beginning to realize that telemed services are cost effective. Aetna, Highmark, and Cigna are now dipping their toes in the water. And in August, BlueCross BlueShield of South Carolina and Blue Choice HealthPlan of South Carolina announced that they would start paying for some telemedicine services. Perhaps the Blues in SC saw the writing on the wall. Legislation requiring private insurers to cover telemed services has been introduced in the state (SB 290 and HB 3779) and will be carried over for the 2014 session.

But a recent tally from the American Telemedicine Association indicates that nationwide coverage will be a slow journey.

As of October 29, there were only 20 states, and the District of Columbia, that required insurance companies to pay for some form of telemedicine services: Arizona, California, Colorado, Georgia, Hawaii, Kansas, Louisiana, Maine, Maryland, Michigan, Minnesota, Mississippi, Montana, New Hampshire, New Mexico, Oklahoma, Oregon, Texas, Vermont, and  Virginia. 

Insurers and state lawmakers aren’t the only ones with reservations about telemedicine. Many clinicians hesitate to get involved for two simple reasons: lack of compensation and lack of time. Ron Dixon, MD,  the Director of the Virtual Practice  at Massachusetts General Hospital, and the second panelist at the Connected Health Symposium, said, “I’ve found trying to get telehealth moving at MGH has been impeded by the way insurers pay for things… It’s been a big barrier to get it rolled into the way physicians actually practice.” He also believes that doctors resist offering telecare because they simply have too much to do. “If you are going to get doctors involved, there has to be a win for them, and the win is usually time. It’s not always about the money.”

Massachusetts General Hospital has built a tool that allows existing patients to get their follow-up care online. The hospital pays providers for the service, and while the fees they receive are less than what they get for in-person visits, it also takes them less time to see a patient online, so it tends to balance out.

Historically, the healthcare industry has been notoriously slow to adopt innovation. Organizations like Massachusetts General Hospital and WellPoint have been bold enough the “resist the resistance” common among their colleagues. Now we need others to follow suit.

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David F. Carr
David F. Carr,
User Rank: Author
11/18/2013 | 11:07:05 AM
Re: Benefits of telemedicine
We've got a related article here: Telemedicine Transforms Rural Care by Alex Kane Rudansky
Paul Cerrato
Paul Cerrato,
User Rank: Apprentice
11/18/2013 | 10:47:12 AM
Re: Benefits of telemedicine
The benefits of a video connection to the patient versus a simple phone call include the ability to examine skin lesons and other visual clues to the patient's condition as you mentioned.  But there are also psychological benefits.  Many patients develop a stronger bond seeing and hearing the doc, rather than just hearing him/her.

And if the telemedicine setup also allows transmission of other patient data--e.g. pulse oximetry, EKG readings, body weight, that would also be an advantage over a simple phone call.


Paul Cerrato
User Rank: Apprentice
11/15/2013 | 6:17:26 PM
What benefit does telemedicine provide that a phone consultation doesn't offer? Is it just a matter of the doctor being able to see the patient's physical symptoms -- a rash, swelling, pale complexion, etc.? -- or is there more to it than that?
Thomas Claburn
Thomas Claburn,
User Rank: Author
11/15/2013 | 1:00:58 PM
New Rules Needed
Because healthcare isn't really an open market, we need better regulations that require healthcare companies to expose pricing data, so consumers can make informed healthcare decisions rather than making choices in the dark.
Rodney Brown
Rodney Brown,
User Rank: Author
11/15/2013 | 12:47:19 PM
Rural states need remote medicine
The list of states that have already legislated a requirement for insurers to cover telemedicine is also a list of states with a significant rural population, for the most part. Being able to tell someone in the woods of northern Maine that his symptoms aren't a reason to rush to a hospital or clinic that could be an hour away will save everyone hassle and money.
Alex Kane Rudansky
Alex Kane Rudansky,
User Rank: Author
11/15/2013 | 9:59:49 AM
Reimbursement barrier
I think once we can get past this reimbursement barrier, telemedicine will be the method of choice for follow-up visits and even primary visits in areas with limited access to specialists. Telemedicine is cost effective, decreases barriers to treatment and increases access for those in rural areas. It has also been proven to increase patient satisfaction, which is ultimately better for a health system's bottom line. 
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